Provider Demographics
NPI:1306071188
Name:JACOTIN, HENRY CLAUDE (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:CLAUDE
Last Name:JACOTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W 118TH ST
Mailing Address - Street 2:3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1057
Mailing Address - Country:US
Mailing Address - Phone:212-933-1053
Mailing Address - Fax:
Practice Address - Street 1:313 W 118TH ST
Practice Address - Street 2:3C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1057
Practice Address - Country:US
Practice Address - Phone:212-933-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine