Healthcare Provider Details

I. General information

NPI: 1194286674
Provider Name (Legal Business Name): XAVIER V JEAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 HARLEM RD STE 240
BUFFALO NY
14225-4031
US

IV. Provider business mailing address

32 BERNHARDT DR APT 4
BUFFALO NY
14226-4448
US

V. Phone/Fax

Practice location:
  • Phone: 716-893-0333
  • Fax:
Mailing address:
  • Phone: 443-670-6768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number330395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: