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General NPI Number Information
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NPI Number | 1619412988
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Entity Type | Organization
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Legal Business Name | JPC MEDICAL PC
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 1552 RALPH AVE
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City | BROOKLYN
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State | NY
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Zip | 11236-3129
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Country | US
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Telephone | 718-629-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 KINGS HWY SUITE 143
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City | BROOKLYN
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State | NY
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Zip | 11229-1210
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Country | US
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Telephone | 718-629-2030
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JEAN P PERNIER
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Credential | MD
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Telephone | 718-629-2030
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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 | 157407-1
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License Number State | NY
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