Provider Demographics
NPI:1770546939
Name:JEAN-MICHEL, MARJORIE (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:JEAN-MICHEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 GRAND CONCOURSE
Mailing Address - Street 2:DEPARTMENT OF OB/GYN, 5TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7606
Mailing Address - Country:US
Mailing Address - Phone:718-239-8389
Mailing Address - Fax:718-239-8360
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:DEPARTMENT OF OB/GYN, 5TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-239-8389
Practice Address - Fax:718-239-8360
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0094120207V00000X
NY250376207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273690000Medicaid
FLI42120Medicare UPIN
FL273690000Medicaid
NYA400005575Medicare PIN