Provider Demographics
NPI:1932348562
Name:ANDRE, JEAN CLAUDE STEPHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:CLAUDE STEPHAN
Last Name:ANDRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-4096
Mailing Address - Fax:718-270-2125
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-4096
Practice Address - Fax:718-270-2125
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003236207Q00000X
NJ25MA08567500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty