Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 204828 | NY |
NPI | 1609945815 |
---|---|
Provider Name | Jacquelin Antoine Belamy |
First Address | Brooklyn, NY 11236-3711 |
Second Address | Brooklyn, NY 11236-3711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 12/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01906009 | (05) | NY |
H20778 | (02) |