Healthcare Provider Details

I. General information

NPI: 1497055636
Provider Name (Legal Business Name): JEAN CLEEFORD BATAILLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11949 226TH ST
CAMBRIA HEIGHTS NY
11411-2121
US

IV. Provider business mailing address

11949 226TH ST
CAMBRIA HEIGHTS NY
11411-2121
US

V. Phone/Fax

Practice location:
  • Phone: 347-525-6961
  • Fax:
Mailing address:
  • Phone: 347-525-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number007427-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: