Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 192191 | NY |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 192191 | NY |
Y | 207R00000X | Internist | 192191 | NY |
Y | 111NI0900X | Internist | 192191 | NY |
NPI | 1073577581 |
---|---|
Provider Name | Dr. Andre Jocelyn Duhamel |
First Address | Bronx, NY 10458-1000 |
Second Address | Bronx, NY 10453-4303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01441038 | (05) | NY |
F57619 | (02) | NY |