Healthcare Provider Details

I. General information

NPI: 1619412988
Provider Name (Legal Business Name): JPC MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 RALPH AVE
BROOKLYN NY
11236-3129
US

IV. Provider business mailing address

1612 KINGS HWY SUITE 143
BROOKLYN NY
11229-1210
US

V. Phone/Fax

Practice location:
  • Phone: 718-629-2030
  • Fax:
Mailing address:
  • Phone: 718-629-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number157407-1
License Number StateNY

VIII. Authorized Official

Name: DR. JEAN P PERNIER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-629-2030