Provider Demographics
NPI:1609945815
Name:BELAMY, JACQUELIN ANTOINE (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:ANTOINE
Last Name:BELAMY
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 1:9613 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3711
Mailing Address - Country:US
Mailing Address - Phone:718-927-1355
Mailing Address - Fax:718-927-1360
Practice Address - Street 1:9613 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3711
Practice Address - Country:US
Practice Address - Phone:718-927-1355
Practice Address - Fax:718-927-1360
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204828207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01906009Medicaid
NY01906009Medicaid
H20778Medicare UPIN