Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 227093 | NY |
NPI | 1053384081 |
---|---|
Provider Name | Jean Garry Lajeune |
First Address | Brookly, NY 11220 |
Second Address | Brooklyn, NY 11220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 27/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02357880 | (05) | NY |
H79689 | (02) |