Healthcare Provider Details

I. General information

NPI: 1073577581
Provider Name (Legal Business Name): ANDRE JOCELYN DUHAMEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 GRAND CONCOURSE
BRONX NY
10453-4303
US

IV. Provider business mailing address

3198 GRAND CONCOURSE
BRONX NY
10458-1000
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-7295
  • Fax:
Mailing address:
  • Phone: 718-618-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number192191
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number192191
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number192191
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: