Provider Demographics
NPI:1720176159
Name:HYACINTHE, JACQUES (MD)
Entity Type:Individual
Prefix:
First Name:JACQUES
Middle Name:
Last Name:HYACINTHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-284-7400
Mailing Address - Fax:718-284-3384
Practice Address - Street 1:3520 AVENUE D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-284-7400
Practice Address - Fax:718-284-3384
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145212208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY145212Medicaid
B01526Medicare UPIN
NY12D783Medicare ID - Type Unspecified