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General NPI Number Information
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NPI Number | 1205007390
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Entity Type | Organization
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Legal Business Name | BROOKLYN PEDIATRIC CARE PLLC
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 2274 PITKIN AVE
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City | BROOKLYN
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State | NY
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Zip | 11207-3718
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Country | US
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Telephone | 718-277-7477
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Fax | 718-277-2801
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Provider Business Mailing Address
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Address Line | 14711 240TH ST
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City | ROSEDALE
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State | NY
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Zip | 11422-2453
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Country | US
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Telephone | 718-277-7477
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Fax | 718-277-2801
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Authorized Official
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Title or Position | MANAGER
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Name | DR. HERVE JACQUES
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Credential | MD
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Telephone | 718-277-7477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 243061
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License Number State | NY
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