Provider Demographics
NPI:1144512674
Name:JACQUES, MAGALIE SAINT-LOT (MD)
Entity type:Individual
Prefix:MRS
First Name:MAGALIE
Middle Name:SAINT-LOT
Last Name:JACQUES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31 BRIDGEWATER CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4030
Mailing Address - Country:US
Mailing Address - Phone:732-642-7863
Mailing Address - Fax:718-221-7633
Practice Address - Street 1:31 BRIDGEWATER CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4030
Practice Address - Country:US
Practice Address - Phone:732-642-7863
Practice Address - Fax:718-221-7633
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAB55186340042084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry