Provider Demographics
NPI:1104241116
Name:JACQUES C. ANTOINE PHYSICIAN, P.C.
Entity type:Organization
Organization Name:JACQUES C. ANTOINE PHYSICIAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTOINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-485-9869
Mailing Address - Street 1:1718 PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-6604
Mailing Address - Country:US
Mailing Address - Phone:718-485-9869
Mailing Address - Fax:
Practice Address - Street 1:1718 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-6604
Practice Address - Country:US
Practice Address - Phone:718-485-9869
Practice Address - Fax:718-485-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center