Provider Demographics
NPI:1083818843
Name:JOSAPHAT, JACQUES
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:
Last Name:JOSAPHAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 98TH ST APT 1G
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3010
Mailing Address - Country:US
Mailing Address - Phone:718-760-8770
Mailing Address - Fax:
Practice Address - Street 1:440 LENOX RD STE 1C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2042
Practice Address - Country:US
Practice Address - Phone:718-221-6170
Practice Address - Fax:718-270-3373
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16180207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology