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General NPI Number Information
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NPI Number | 1881833713
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Entity Type | Organization
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Legal Business Name | JACQUES MEDICAL SERVICES PLLC
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 1618 NEW YORK AVE
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-2418
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Country | US
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Telephone | 631-421-2190
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Fax | 631-421-2695
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Provider Business Mailing Address
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Address Line | 1618 NEW YORK AVE
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-2418
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Country | US
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Telephone | 631-421-2190
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Fax | 631-421-2695
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Authorized Official
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Title or Position | PHYSCIAL
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Name | MARIE CARMEL JACQUES
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Credential | M.D.
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Telephone | 631-421-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 199373
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License Number State | NY
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