Individual
JEAN EDOUARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
640 W 232ND ST, BRONX, NY 10463-3207
(718) 884-2992
Mailing address
5676 RIVERDALE AVE, BRONX, NY 10471-2138
(718) 796-5300
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
NYCPS-P300
NY
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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