Individual
DR. JEAN-ETIENNE THIBAUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1713-19 RALPH AVE, 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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00695941
—
NY
05
—
02366750
—
NY
Enumeration date
08/16/2006
Last updated
07/02/2008
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