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General NPI Number Information
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NPI Number | 1790778264
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Entity Type | Individual
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Provider Name | JACQUELIN EMMANUEL MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 75 E 116TH ST
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City | NEW YORK
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State | NY
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Zip | 10029-1150
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Country | US
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Telephone | 212-828-7700
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Fax | 212-828-7800
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Provider Business Mailing Address
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Address Line | 8432 MIDLAND PKWY
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City | JAMAICA
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State | NY
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Zip | 11432-2219
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Country | US
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Telephone | 718-658-7116
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Fax | 212-828-7800
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 135799
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License Number State | NY
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