Provider Demographics
NPI:1750469052
Name:WINTER, JACQUES (MD)
Entity Type:Individual
Prefix:
First Name:JACQUES
Middle Name:
Last Name:WINTER
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 1:755 NEW YORK AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4240
Mailing Address - Country:US
Mailing Address - Phone:631-351-1250
Mailing Address - Fax:631-351-1321
Practice Address - Street 1:755 NEW YORK AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4240
Practice Address - Country:US
Practice Address - Phone:631-351-1250
Practice Address - Fax:631-351-1321
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1445552084B0040X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY144555OtherLICENSE
NY144555OtherLICENSE
NY93A081Medicare ID - Type Unspecified
NY144555OtherLICENSE
B79845Medicare UPIN