Organization
FAITH FAMILY MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEAN-ETIENNE THIBAUD DO (PRESIDENT)
(718) 531-6100
Entity
Organization
Contact information
Practice address
1713-19 RALPH AVENUE, BROOKLYN, NY 11236
(718) 531-6100
(718) 531-2329
Mailing address
PO BOX 100714, VANDERVEER STATION, BROOKLYN, NY 11210-0714
(718) 531-6100
(718) 531-2329
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
224277
NY
Other
Enumeration date
08/16/2006
Last updated
08/22/2020
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