Healthcare Provider Details

I. General information

NPI: 1881969442
Provider Name (Legal Business Name): DOUECK ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 KINGS HWY
BROOKLYN NY
11223-2003
US

IV. Provider business mailing address

563 KINGS HWY
BROOKLYN NY
11223-2003
US

V. Phone/Fax

Practice location:
  • Phone: 718-339-7982
  • Fax: 718-375-7742
Mailing address:
  • Phone: 718-339-7982
  • Fax: 718-375-7742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUES M. DOUECK
Title or Position: PRESIDENT
Credential: DDS
Phone: 718-339-7982