Provider Demographics
NPI:1922078997
Name:PICHE, JACQUES (MD, FRSC (C))
Entity Type:Individual
Prefix:
First Name:JACQUES
Middle Name:
Last Name:PICHE
Suffix:
Gender:M
Credentials:MD, FRSC (C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HEALEY AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2413
Mailing Address - Country:US
Mailing Address - Phone:518-566-7930
Mailing Address - Fax:518-566-7932
Practice Address - Street 1:10 HEALEY AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2413
Practice Address - Country:US
Practice Address - Phone:518-566-7930
Practice Address - Fax:518-566-7932
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219568-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000499084001OtherBLUE SHIELD NORTHEASTERN
NY02203029Medicaid
NY141828127OtherUNITED HEALTHCARE
NY5R609OtherBLUE CROSS
NY02203029Medicaid