Provider Demographics
NPI:1225425507
Name:JEANLOUIS, LIONEL (RRT)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:JEANLOUIS
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 VALLEY FORGE DR
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1225
Mailing Address - Country:US
Mailing Address - Phone:631-505-7632
Mailing Address - Fax:
Practice Address - Street 1:9 VALLEY FORGE DR
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-1225
Practice Address - Country:US
Practice Address - Phone:631-505-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005278-1227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered