Healthcare Provider Details

I. General information

NPI: 1316027212
Provider Name (Legal Business Name): PIERRE CAROUSSE JEAN FELIX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

35 PAERDEGAT 2ND ST
BROOKLYN NY
11236-4131
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8000
  • Fax: 347-429-0627
Mailing address:
  • Phone: 347-429-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number152032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: