Individual provider Active NPI

Sergine Desrosiers, DPM

  • Orthopaedic Foot and Ankle Surgery Physician
  • Brooklyn, NY
National Provider Identifier
1093709610
Registry record updated Sep 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Foot and Ankle Surgery PhysicianTaxonomy code 207XX0004X
License
N005664-1 Issued in NY
Practice address
613 Throop Ave
Brooklyn, NY 11216-2522
Phone
(718) 602-6200
NPI assigned
Sep 9, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X N005664-1 NY Primary
Primary Podiatric Medicine Podiatrist 213EP1101X MD002675 NJ
Primary Podiatric Medicine Podiatrist 213EP1101X SC005652 PA

Addresses

Primary practice location

613 Throop Ave
Brooklyn, NY 11216-2522

Mailing address

445 Lenox Rd
Box1262
Brooklyn, NY 11203-2017
Phone (718) 602-6200

Other identifiers 2

IdentifierTypeStateIssuer
8696900MedicaidNJ
1964230004MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20031110000559 NJ Practitioner - Podiatry 6002729696 Practice locations: Burlington, NJ
I20040310000594 PA Practitioner - Podiatry 6002729696 Practice locations: Bristol, PA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
N005664-1NYMDOrthopaedic Foot and Ankle Surgery Physician
MD002675NJMDPrimary Podiatric Medicine Podiatrist
SC005652PAMDPrimary Podiatric Medicine Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jay M Purvin, DPM Primary Podiatric Medicine Past Accepting new patients
Warren a Rubin DPM Past Accepting new patients
Eugene Dyakovetsky MD. PC. Past Accepting new patients
Jeffrey L. Morer, OD, PC Past Accepting new patients
Healthdrive Podiatry Group, PC Past Accepting new patients
Desiree D. Nelson-Kelly, DPM Primary Podiatric Medicine Past Accepting new patients

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380067200000",
    "number": "1093709610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 LENOX RD",
            "address_2": "BOX1262",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032017",
            "telephone_number": "718-602-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 THROOP AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112162522",
            "telephone_number": "718-602-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESROSIERS",
        "first_name": "SERGINE",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-09",
        "last_updated": "2013-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "NY",
            "license": "N005664-1",
            "primary": true
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "NJ",
            "license": "MD002675",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "PA",
            "license": "SC005652",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8696900",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1964230004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.