Provider Demographics
NPI:1831329135
Name:DESLOUCHES, ROOLS (NP,)
Entity type:Individual
Prefix:
First Name:ROOLS
Middle Name:
Last Name:DESLOUCHES
Suffix:
Gender:M
Credentials:NP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4498
Mailing Address - Country:US
Mailing Address - Phone:631-947-0030
Mailing Address - Fax:
Practice Address - Street 1:820 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4498
Practice Address - Country:US
Practice Address - Phone:631-947-0030
Practice Address - Fax:631-947-7888
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305163363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health