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General NPI Number Information
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NPI Number | 1104241116
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Entity Type | Organization
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Legal Business Name | JACQUES C. ANTOINE PHYSICIAN, P.C.
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Dates
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Enumeration Date | 02/27/2014
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 1718 PITKIN AVE
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City | BROOKLYN
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State | NY
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Zip | 11212-6604
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Country | US
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Telephone | 718-485-9869
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Fax | 718-485-4213
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Provider Business Mailing Address
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Address Line | 1718 PITKIN AVE
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City | BROOKLYN
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State | NY
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Zip | 11212-6604
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Country | US
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Telephone | 718-485-9869
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | JACQUES ANTOINE
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Credential | M.D.
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Telephone | 718-485-9869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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