Provider Demographics
NPI:1588658553
Name:CANTAVE, JEANINE MARIE CELIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:MARIE CELIE
Last Name:CANTAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3642
Mailing Address - Country:US
Mailing Address - Phone:631-249-2765
Mailing Address - Fax:631-249-3617
Practice Address - Street 1:750 FULTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3642
Practice Address - Country:US
Practice Address - Phone:631-249-2765
Practice Address - Fax:631-249-3617
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1939782084P0800X
FLME858862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F91745Medicare UPIN
NY86J621Medicare UPIN