Provider Demographics
NPI:1912253592
Name:YUNIQUE A DESIRE-BRISARD FNP LNC
Entity Type:Organization
Organization Name:YUNIQUE A DESIRE-BRISARD FNP LNC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUNIQUE
Authorized Official - Middle Name:AMBER
Authorized Official - Last Name:DESIRE-BRISARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:718-373-2563
Mailing Address - Street 1:380 AVENUE U
Mailing Address - Street 2:STE# 1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4046
Mailing Address - Country:US
Mailing Address - Phone:718-373-2563
Mailing Address - Fax:718-339-4470
Practice Address - Street 1:1339 E 104TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:718-373-2563
Practice Address - Fax:718-339-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty