Provider Demographics
NPI:1780099804
Name:LOUIS, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:LOUIS
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 1:35 EASON DR
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-3111
Mailing Address - Country:US
Mailing Address - Phone:631-345-6501
Mailing Address - Fax:718-307-5547
Practice Address - Street 1:35 EASON DR
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-3111
Practice Address - Country:US
Practice Address - Phone:631-345-6501
Practice Address - Fax:718-307-5547
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator