1578679759 NPI number — JACQUES M DELPHIN MD

Table of content: JACQUES M DELPHIN MD (NPI 1578679759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578679759 NPI number — JACQUES M DELPHIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELPHIN
Provider First Name:
JACQUES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1578679759
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:
20 DAVIS AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12603-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-485-3500
Provider Business Mailing Address Fax Number:
845-485-8780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 HAIGHT AVENUE SUITE 102
Provider Second Line Business Practice Location Address:
SPRECTRUM BEHAVIORAL MANAGEMENT SERV INC
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12603-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-485-9098
Provider Business Practice Location Address Fax Number:
845-485-8780
Provider Enumeration Date:
08/21/2006

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: 2084P0800X , with the licence number:  98544 , 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: 1033150 . This is a "BEACON HEALTH STRAT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0050145 . This is a "VALUEOPTIONS EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1027945 . This is a "CIGNA BEH HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16111 . This is a "PONCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 137126 . This is a "VALUEOPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10033708 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5242751 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 361015 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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