Provider Demographics
NPI:1235294950
Name:LOUIS, JEAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ROBERT
Last Name:LOUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:ROBERT
Other - Last Name:LOUIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18 OLDFIELD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2810
Mailing Address - Country:US
Mailing Address - Phone:516-587-4200
Mailing Address - Fax:
Practice Address - Street 1:55 MAPLE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3800
Practice Address - Country:US
Practice Address - Phone:516-764-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184745207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1347171Medicaid
NY1347171Medicaid
NYF49064Medicare UPIN