Provider Demographics
NPI:1114382090
Name:JACQUELYN S. LAHOUD, M.D. P.C.
Entity Type:Organization
Organization Name:JACQUELYN S. LAHOUD, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAHOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-414-4505
Mailing Address - Street 1:9917 SHORE RD APT 4C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7925
Mailing Address - Country:US
Mailing Address - Phone:917-414-4505
Mailing Address - Fax:
Practice Address - Street 1:7515 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2409
Practice Address - Country:US
Practice Address - Phone:917-414-4505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272160207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A300127612Medicare PIN