Provider Demographics
NPI:1497114862
Name:JEAN, CATRINA (DO)
Entity Type:Individual
Prefix:
First Name:CATRINA
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CATRINA
Other - Middle Name:
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:685 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-5545
Mailing Address - Country:US
Mailing Address - Phone:914-787-4100
Mailing Address - Fax:914-787-4199
Practice Address - Street 1:14-02 150TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1764
Practice Address - Country:US
Practice Address - Phone:718-353-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296779207Q00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program