Provider Demographics
NPI:1770677353
Name:JEAN-GILLES, MAX (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:JEAN-GILLES
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 1:2 TAMARA COURT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1146
Mailing Address - Country:US
Mailing Address - Phone:631-643-5382
Mailing Address - Fax:718-264-2744
Practice Address - Street 1:160 PARKSIDE AVENUE
Practice Address - Street 2:SUITE 1DE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:718-469-5157
Practice Address - Fax:718-940-6819
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165341207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB79288Medicare UPIN