Provider Demographics
NPI:1316027212
Name:JEAN FELIX, PIERRE CAROUSSE (MD)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:CAROUSSE
Last Name:JEAN FELIX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PAERDEGAT 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4131
Mailing Address - Country:US
Mailing Address - Phone:347-429-0627
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:347-429-0627
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152032204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00783459Medicaid
NYB13809Medicare UPIN
NY36D721Medicare ID - Type Unspecified