Provider Demographics
NPI:1417392853
Name:SOUFFRANT, GEORGES MAXIME
Entity Type:Individual
Prefix:MR
First Name:GEORGES
Middle Name:MAXIME
Last Name:SOUFFRANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BROADWAY APT D7D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-8704
Mailing Address - Country:US
Mailing Address - Phone:954-678-7903
Mailing Address - Fax:
Practice Address - Street 1:3333 BROADWAY APT D7D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-8704
Practice Address - Country:US
Practice Address - Phone:954-678-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1324444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist