MEDICARE: DR. JEAN HEROLD ANCION 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	208M00000X	Hospitalist Physician	245310	NY
2	208M00000X	Hospitalist Physician	53543	CT
3	207R00000X	Internal Medicine Physician	245310	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	:	1265609127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN HEROLD ANCION M.D.

Provider Business Mailing Address
First Line	:	10418 220TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-2145
Country	:	US
Telephone Number	:	917-204-9723
Fax Number	:

Provider Business Practice Location Address
First Line	:	4213 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3011
Country	:	US
Telephone Number	:	718-287-0868
Fax Number	:	718-287-1375

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

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	04/28/2025

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