Provider Demographics
NPI:1356401210
Name:DESROCHES, JOSEPH & SCOTT MD PC
Entity type:Organization
Organization Name:DESROCHES, JOSEPH & SCOTT MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:516-369-3449
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11582-0516
Mailing Address - Country:US
Mailing Address - Phone:516-285-2850
Mailing Address - Fax:
Practice Address - Street 1:2015 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4000
Practice Address - Country:US
Practice Address - Phone:516-285-2850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172523174400000X
NY176037174400000X
NY176371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty