Healthcare Provider Details

I. General information

NPI: 1063834547
Provider Name (Legal Business Name): MR. MAGGNEL JEAN PIERRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 TILLOTSON AVE
BRONX NY
10475-1583
US

IV. Provider business mailing address

6424 18TH AVE FL 2
BROOKLYN NY
11204-3729
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-2100
  • Fax:
Mailing address:
  • Phone: 212-687-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number749243
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number3091011
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: