Provider Demographics
NPI:1760365514
Name:DEBROSSE, ELLIOT THOMAS
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:THOMAS
Last Name:DEBROSSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HORSEBLOCK RD STE H
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1252
Mailing Address - Country:US
Mailing Address - Phone:631-233-9490
Mailing Address - Fax:
Practice Address - Street 1:400 HORSEBLOCK RD STE H
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1252
Practice Address - Country:US
Practice Address - Phone:631-233-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY407352363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health