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NPI Code Detail

MEDICARE: JACQUES C. ANTOINE PHYSICIAN, P.C.

MEDICARE: JACQUES C. ANTOINE PHYSICIAN, P.C.
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1104241116
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACQUES C. ANTOINE PHYSICIAN, P.C.
Provider Business Mailing Address
First Line : 1718 PITKIN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-6604
Country : US
Telephone Number : 718-485-9869
Fax Number :
Provider Business Practice Location Address
First Line : 1718 PITKIN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-6604
Country : US
Telephone Number : 718-485-9869
Fax Number : 718-485-4213
Authorized Official
Title or Position : OWNER/PHYSICIAN
Name : JACQUES ANTOINE
Credential : M.D.
Telephone Number : 718-485-9869
Provider Enumeration Date : 02/27/2014
Last Update Date : 02/27/2014

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