Provider Demographics
NPI:1235177668
Name:RENAUD, JEAN LEOPOLD EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN LEOPOLD
Middle Name:EDWIN
Last Name:RENAUD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10540 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4604
Mailing Address - Country:US
Mailing Address - Phone:718-241-1784
Mailing Address - Fax:718-940-0907
Practice Address - Street 1:76 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3104
Practice Address - Country:US
Practice Address - Phone:718-940-3000
Practice Address - Fax:718-940-0907
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY226985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI07240Medicare UPIN