Basic Information
| Provider Information | |||||||||
| NPI: | 1053780510 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL PRACTICE OF JEAN-FRANCOIS & LAROCHE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112264403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186932800 | ||||||||
| FaxNumber: | 7186933724 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112264403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186932800 | ||||||||
| FaxNumber: | 7186933724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2015 | ||||||||
| LastUpdateDate: | 09/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | JEAN-FRANCOIS | ||||||||
| AuthorizedOfficialFirstName: | THEODORE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTORE | ||||||||
| AuthorizedOfficialTelephone: | 7186932800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 159564 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 207R00000X | 154993 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.