Provider Demographics
NPI:1356179998
Name:DURANDISSE, JOUBERT G
Entity type:Individual
Prefix:
First Name:JOUBERT
Middle Name:G
Last Name:DURANDISSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NOSTRAND AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4042
Mailing Address - Country:US
Mailing Address - Phone:929-557-0806
Mailing Address - Fax:
Practice Address - Street 1:9413 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3726
Practice Address - Country:US
Practice Address - Phone:718-272-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist