Provider Demographics
NPI:1427137322
Name:JOSPITRE, JACQUES JR (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:
Last Name:JOSPITRE
Suffix:JR
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 1:110 LAFAYETTE ST
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4116
Mailing Address - Country:US
Mailing Address - Phone:212-369-6757
Mailing Address - Fax:212-369-3941
Practice Address - Street 1:110 LAFAYETTE ST
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4116
Practice Address - Country:US
Practice Address - Phone:212-369-6757
Practice Address - Fax:212-369-3941
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2281712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02548292Medicaid
NY02548292Medicaid
472BG1Medicare PIN