Provider Demographics
NPI:1144207275
Name:SAINT-JACQUES, HENOCK (MD)
Entity type:Individual
Prefix:
First Name:HENOCK
Middle Name:
Last Name:SAINT-JACQUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-0825
Mailing Address - Country:US
Mailing Address - Phone:212-348-9400
Mailing Address - Fax:212-348-9405
Practice Address - Street 1:1787 MADISON AVE
Practice Address - Street 2:SUITE 50C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4518
Practice Address - Country:US
Practice Address - Phone:212-348-9400
Practice Address - Fax:212-348-9405
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219132207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H63519Medicare UPIN
NY539Q51Medicare PIN