MEDICARE: DR. JEFFREY CARLOS JACQUES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	215533	NY

General Provider Information

NPI Number	:	1972962306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY CARLOS JACQUES

Provider Business Mailing Address
First Line	:	760 W END AVE
Second Line	:	APT. 11E
City	:	NEW YORK
State	:	NY
Zip	:	10025-5523
Country	:	US
Telephone Number	:	917-284-8624
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 W END AVE
Second Line	:	APT. 11E
City	:	NEW YORK
State	:	NY
Zip	:	10025-5523
Country	:	US
Telephone Number	:	917-284-8624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2016
Last Update Date	:	02/13/2016

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