Provider Demographics
NPI:1245358340
Name:JOSEPH & DESROCHES MD PC
Entity type:Organization
Organization Name:JOSEPH & DESROCHES MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position: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:516-285-2850
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 1:1975 LINDEN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4004
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:2007-03-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172523174400000X
NY176371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
172523POtherHEALTHCARE PARTNERS
NY01305357Medicaid
AS699OtherOXFORD
176371POtherHEALTHCAREPARTNERS
2501072OtherGHI
176371SOtherHEALTHCARE PARTNERS
NY01305348Medicaid
NY172523OtherLICENSE
172523SOtherHEALTHCARE PARTNERS
NY176371OtherLICENSE
NY97F153OtherBLUE CROSS & BLUE SHIELD
P1069572OtherOXFORD
NY00G361OtherBLUE CROSS & BLUE SHIELD
164450OtherELDERPLAN
AS699OtherOXFORD
NY97F153OtherBLUE CROSS & BLUE SHIELD
176371POtherHEALTHCAREPARTNERS
176371SOtherHEALTHCARE PARTNERS
172523POtherHEALTHCARE PARTNERS