MEDICARE: JACQUES DUPERVAL M.D.

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	208600000X	Surgery Physician	182104	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184681033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUES DUPERVAL M.D.

Provider Business Mailing Address
First Line	:	60 PLAZA ST E
Second Line	:	SUITE S-3
City	:	BROOKLYN
State	:	NY
Zip	:	11238-5040
Country	:	US
Telephone Number	:	718-783-5168
Fax Number	:	718-783-0408

Provider Business Practice Location Address
First Line	:	60 PLAZA ST E
Second Line	:	SUITE S-3
City	:	BROOKLYN
State	:	NY
Zip	:	11238-5040
Country	:	US
Telephone Number	:	718-783-5168
Fax Number	:	718-783-0408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/28/2010

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