Provider Demographics
NPI:1972675601
Name:ERNST F JEAN MD PC
Entity Type:Organization
Organization Name:ERNST F JEAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ERNST
Authorized Official - Middle Name:F
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-523-2200
Mailing Address - Street 1:8759 171ST ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4554
Mailing Address - Country:US
Mailing Address - Phone:718-523-2200
Mailing Address - Fax:
Practice Address - Street 1:8759 171ST ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4554
Practice Address - Country:US
Practice Address - Phone:718-523-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01119286Medicaid
NY01119286Medicaid
NYE42020Medicare UPIN
NY09227Medicare ID - Type Unspecified