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General NPI Number Information
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NPI Number | 1083954648
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Entity Type | Organization
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Legal Business Name | JACQUES DUPERVAL, MD, FICS, FACS, PC
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 60 PLAZA STREET EAST SUITE S-3
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City | BROOKLYN
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State | NY
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Zip | 11238
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Country | US
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Telephone | 718-783-5168
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Fax | 718-783-0408
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Provider Business Mailing Address
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Address Line | 60 PLAZA STREET EAST SUITE S-3
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City | BROOKLYN
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State | NY
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Zip | 11238
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Country | US
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Telephone | 718-783-5168
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Fax | 718-783-0408
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JACQUES DUPERVAL
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Credential | M.D
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Telephone | 718-783-5168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | NY
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