Provider Demographics
NPI:1063445153
Name:FUTORAN, JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:FUTORAN
Suffix:
Gender:F
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:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-0195
Mailing Address - Country:US
Mailing Address - Phone:718-265-9914
Mailing Address - Fax:516-625-5553
Practice Address - Street 1:2327 83RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2750
Practice Address - Country:US
Practice Address - Phone:718-265-9914
Practice Address - Fax:718-265-9219
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206254208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06783GOtherGHI MEDICARE
NY06783GOtherGHI MEDICARE
NY25Z701Medicare PIN