Desiree Bollerup, AGPCNP
Individual provider Active NPI Adult Health Nurse Practitioner · Greenlawn, NY
NPI 1669250098 · NPPES record last updated Sep 18, 2023
Key facts
- NPI
- 1669250098
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- F311371-01 (NY)
- Practice address
- 284 Pulaski Rd
Greenlawn, NY 11740-1602 - Phone
- (631) 425-5250
- NPI assigned
- Sep 18, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Huntington Hospital Dolan Family Health Center
Practice addresses (Care Compare)
1448 5TH Ave
Bay Shore, NY 11706-4147
Phone (516) 876-5927
1572 New York Ave
Huntington Station, NY 11746-2418
Phone (631) 425-5250
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240403001914 | NY | Practitioner - Nurse Practitioner | 5496193914 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 311371 | NY | MD | Hospitalist Physician |
| F311371-01 | NY | MD | Adult Health Nurse Practitioner |
Practice roles (2 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Huntington Hospital Dolan Family Health Center | Current |
Accepting new patients | |
| North Shore-Lij Medical PC | Past | Accepting new patients |
Locations
1448 5th Ave
Bay Shore, NY 11706
Phone (631) 309-6831
284 Pulaski Rd
Greenlawn, NY 11740
Phone (631) 425-5250
1572 New York Ave
Huntington Station, NY 11746
Phone (631) 425-5250
1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
Interoperability endpoints
- dbollerup60943@northwell.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | F311371-01 | NY | Yes |
Addresses
Primary practice location
284 Pulaski Rd
Greenlawn, NY 11740-1602
Mailing address
284 Pulaski Rd
Greenlawn, NY 11740-1602
Other names
- Desiree Bollerup
Other providers in Greenlawn, NY
- Robin Lynn Blosser
- Katherine Louise Boder
- Kip Lord Bodi
- Joyce Bohn
- Patricia A Boller
- Andrea Boltwood
- Gary J Bouchard
- Rachel Pearl Bouvin
- Carrol Brandt
- Bright Horizon Speech Therapy
All providers in Greenlawn, NY · Adult Health Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.