Provider Demographics
NPI:1376258731
Name:METAYER, JEAN RONEL (MD, PA)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:RONEL
Last Name:METAYER
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:RONEL
Other - Last Name:METAYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:6730 CLYDE ST APT 1G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4004
Mailing Address - Country:US
Mailing Address - Phone:347-485-4717
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:347-485-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1129-P.A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical