Provider Demographics
NPI:1417997347
Name:JEAN-BART, ROBERT Y (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:Y
Last Name:JEAN-BART
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 1:7558 113TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7427
Mailing Address - Country:US
Mailing Address - Phone:718-268-9595
Mailing Address - Fax:718-268-9528
Practice Address - Street 1:7558 113TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7427
Practice Address - Country:US
Practice Address - Phone:718-268-9595
Practice Address - Fax:718-268-9528
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1904912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01608759Medicaid
F61764Medicare UPIN
00148Medicare ID - Type Unspecified