Individual
REGINALD ROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
340 HOWELLS RD, BAY SHORE, NY 11706-5322
(833) 547-7463
(631) 248-5583
Mailing address
100 MOTOR PARKWAY, LL8, HAUPPAUGE, NY 11788
(833) 547-7463
(631) 248-5583
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
228851
NY
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
228851
NY
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
228851
NY
208VP0000X
Pain Medicine Physician
228851
NY
208VP0014X
Interventional Pain Medicine Physician
228851
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02717366
—
NY
Enumeration date
12/20/2005
Last updated
04/29/2024
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