Healthcare Provider Details

I. General information

NPI: 1699530758
Provider Name (Legal Business Name): EMMANUEL JEAN BAPTISTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2676 GRAND CONCRS
BRONX NY
10458-4914
US

IV. Provider business mailing address

8914 216TH ST
QUEENS VILLAGE NY
11427-2408
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-6272
  • Fax:
Mailing address:
  • Phone: 305-917-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number9998
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: