Provider Demographics
NPI:1063476232
Name:BEAUBRUN, PIERRE RONALD (MD)
Entity Type:Individual
Prefix:MR
First Name:PIERRE
Middle Name:RONALD
Last Name:BEAUBRUN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:CREDENTIALING 2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:233 NOSTRAND AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205
Practice Address - Country:US
Practice Address - Phone:718-826-5911
Practice Address - Fax:718-826-5860
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1782391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03546210Medicaid
NY03546210Medicaid