Provider Demographics
NPI:1891785689
Name:DESERRE, STEVE FRANCIS (CNM)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:FRANCIS
Last Name:DESERRE
Suffix:
Gender:M
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:101 JORDAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8343
Practice Address - Country:US
Practice Address - Phone:518-274-0476
Practice Address - Fax:518-274-0497
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2019-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY000767367A00000X
NYF000767176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02555948Medicaid
NY02555948Medicaid
NYRA1789Medicare ID - Type Unspecified
NYQ15921Medicare UPIN