Individual
JEAN A FREDERIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A
Contact information
Practice address
121 DEKALB AVE, BROOKLYN, BROOKLYN, NY 11201-5425
(718) 250-8103
Mailing address
121 DEKALB AVE, BROOKLYN, BROOKLYN, NY 11201-5425
(718) 250-8103
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
003751-1
NY
Other
Enumeration date
07/16/2007
Last updated
07/16/2007
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