MEDICARE: RONALD JACQUES MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	155412	NY

General Provider Information

NPI Number	:	1023387941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD JACQUES MD PC

Provider Business Mailing Address
First Line	:	3009 GLENWOOD RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3009 GLENWOOD RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2641
Country	:	US
Telephone Number	:	718-421-1003
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	RONALD JACQUES
Credential	:
Telephone Number	:	718-421-1003

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	12/21/2011

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