MEDICARE: JEAN-CLAUDE JEAN 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	207R00000X	Internal Medicine Physician

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	:	1922374768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEAN-CLAUDE JEAN MD PC

Provider Business Mailing Address
First Line	:	115 72 FRANCIS LEWIS BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11411-1028
Country	:	US
Telephone Number	:	718-712-6660
Fax Number	:	718-712-3478

Provider Business Practice Location Address
First Line	:	11572 FRANCIS LEWIS BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11411-1028
Country	:	US
Telephone Number	:	718-712-6660
Fax Number	:	718-712-3478

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEAN-CLAUDE JEAN
Credential	:	MD
Telephone Number	:	718-712-6660

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/27/2012

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