Healthcare Provider Details

I. General information

NPI: 1053780510
Provider Name (Legal Business Name): MEDICAL PRACTICE OF JEAN-FRANCOIS & LAROCHE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 OCEAN AVE
BROOKLYN NY
11226-4403
US

IV. Provider business mailing address

622 OCEAN AVE
BROOKLYN NY
11226-4403
US

V. Phone/Fax

Practice location:
  • Phone: 718-693-2800
  • Fax: 718-693-3724
Mailing address:
  • Phone: 718-693-2800
  • Fax: 718-693-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number154993
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number159564
License Number StateNY

VIII. Authorized Official

Name: DR. THEODORE R JEAN-FRANCOIS
Title or Position: DOCTORE
Credential: MD
Phone: 718-693-2800