Provider Demographics
NPI:1407855984
Name:RAYMOND, JACQUES CAROL (MD)
Entity Type:Individual
Prefix:
First Name:JACQUES
Middle Name:CAROL
Last Name:RAYMOND
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 1:294 CENTRAL AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3414
Mailing Address - Country:US
Mailing Address - Phone:973-676-6556
Mailing Address - Fax:973-676-6543
Practice Address - Street 1:294 CENTRAL AVE
Practice Address - Street 2:FL 1
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3414
Practice Address - Country:US
Practice Address - Phone:973-676-6556
Practice Address - Fax:973-676-6543
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO7123300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00624016OtherMEDICARE RAILROAD CARRIER
NJ044641Medicare ID - Type Unspecified
NJ044641UXXMedicare PIN
NJ044641MK3Medicare PIN
NJ044641CLDMedicare PIN