1588869192 NPI number — DR. GERALDINE M JEAN D.O

Table of content: DR. GERALDINE M JEAN D.O (NPI 1588869192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588869192 NPI number — DR. GERALDINE M JEAN D.O

Organization/Personal Information

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

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:
1588869192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 NORTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONEONTA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13820-2629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-432-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COMMUNITY MEDICAL ASSOCIATES INC
Provider Second Line Business Practice Location Address:
4001 DUTCHMANS LANE
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-1270
Provider Business Practice Location Address Fax Number:
502-894-1321
Provider Enumeration Date:
06/15/2007

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: 207V00000X , with the licence number:  264482 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 03086 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03723200 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com