Provider Demographics
NPI:1972001576
Name:LOUIS, JEAN E (MSED)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:LOUIS
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 47 PLYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6842
Mailing Address - Country:US
Mailing Address - Phone:631-944-1103
Mailing Address - Fax:
Practice Address - Street 1:8038 211TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1013
Practice Address - Country:US
Practice Address - Phone:844-344-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty