Provider Demographics
NPI:1144264250
Name:MATHIEU, JACQUES JUDE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:JUDE
Last Name:MATHIEU
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 1:125 WORTH ST
Mailing Address - Street 2:BOX 22 RM 901 NYCDOHMH DIVISION OF DISEASE CONTROL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4006
Mailing Address - Country:US
Mailing Address - Phone:212-788-4711
Mailing Address - Fax:212-788-4734
Practice Address - Street 1:295 FLATBUSH AVENUE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-643-8357
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187844207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G196550Medicare UPIN
NY0105AYMedicare ID - Type UnspecifiedGHI
NY0105AZMedicare ID - Type UnspecifiedGHI
NY93S351Medicare ID - Type UnspecifiedEMPIRE