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NPI Code Detail

MEDICARE: JUAN VAILLANT MEDICAL PLLC

MEDICARE: JUAN VAILLANT MEDICAL PLLC
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
1207N00000XDermatology Physician

General Provider Information

NPI Number : 1295132991
Entity Type Code : Organization
Provider Name (Legal Business Name) : JUAN VAILLANT MEDICAL PLLC
Provider Business Mailing Address
First Line : 2818 STEINWAY ST
Second Line :
City : ASTORIA
State : NY
Zip : 11103-3349
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2818 STEINWAY ST
Second Line :
City : ASTORIA
State : NY
Zip : 11103-3349
Country : US
Telephone Number : 718-892-9373
Fax Number :
Authorized Official
Title or Position : PHYSICIAN/OWNER
Name : JUAN VAILLANT
Credential : M.D.
Telephone Number : 718-892-9373
Provider Enumeration Date : 11/24/2014
Last Update Date : 11/24/2014

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Directions to “JUAN VAILLANT MEDICAL PLLC ” Practice Location

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