1255458618 NPI number — DR. JEAN RAPHAEL YVON DUPOUX M.D.

Table of content: (NPI 1538238571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255458618 NPI number — DR. JEAN RAPHAEL YVON DUPOUX M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUPOUX
Provider First Name:
JEAN
Provider Middle Name:
RAPHAEL YVON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255458618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24812 139TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11422-2205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-276-6043
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COMPREHENSIVE HEALTH CARE & REHABILITATION SVC., LLC
Provider Second Line Business Practice Location Address:
148 WILSON AVE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11237-3149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-455-5500
Provider Business Practice Location Address Fax Number:
718-455-8700
Provider Enumeration Date:
03/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  178289 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02810759 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".