Healthcare Provider Details

I. General information

NPI: 1841194487
Provider Name (Legal Business Name): JERRY ALEXANDER JEAN BAPTISTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EMPIRE BLVD
BROOKLYN NY
11225-3202
US

IV. Provider business mailing address

8806 FLATLANDS AVE
BROOKLYN NY
11236-3612
US

V. Phone/Fax

Practice location:
  • Phone: 718-857-4646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number037114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: