Elizabeth Desgrottes

Primary specialty

SpecialistTaxonomy code 174400000X

License

624103122 Issued in NY

Practice address

236 2ND Ave
New York, NY 10003-2704

Phone

(212) 683-8905

NPI assigned

Jul 6, 2012

Last updated

Jul 6, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Elizabeth Memnon Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1341532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341532800000",
    "number": "1225393135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14252 231ST ST",
            "city": "LAURELTON",
            "state": "NY",
            "postal_code": "114133626",
            "telephone_number": "646-247-6207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 2ND AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100032704",
            "telephone_number": "212-683-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESGROTTES",
        "first_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-06",
        "last_updated": "2012-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "624103122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SERVICE PROVIDER SPECIALIST",
            "identifier": "174400000X",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "MEMNON",
            "prefix": "MS.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Xavier Deschenes-Simard, MD, PHD
• Cheryl Descipio, PH.D.
• Olivia Descorbeth
• Matthew Descovich
• Dita Desena
• Stephanie Desgrottes, M.D.
• Maya Deshmukh
• Loula Deshommes
• Jadis Taylor Deshong-Venay
• Ajit Rajendra Deshpande, MD

• Specialist in New York, NY
• Providers in New York, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.