Provider Demographics
NPI:1245453182
Name:GRACIA, JACQUES H
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:H
Last Name:GRACIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JACQUES
Other - Middle Name:H
Other - Last Name:GRACIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-0271
Mailing Address - Country:US
Mailing Address - Phone:347-601-1200
Mailing Address - Fax:
Practice Address - Street 1:2378A RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5515
Practice Address - Country:US
Practice Address - Phone:516-771-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2017-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3428225200000X
NY002510171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant