Provider Demographics
NPI:1528090099
Name:JACQUETTE, GERMAINE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:GERMAINE
Middle Name:MARIE
Last Name:JACQUETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 GARRETSON RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-1830
Mailing Address - Country:US
Mailing Address - Phone:845-422-1537
Mailing Address - Fax:
Practice Address - Street 1:50 SANITORIUM RD
Practice Address - Street 2:BUILDING D
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3555
Practice Address - Country:US
Practice Address - Phone:845-364-2710
Practice Address - Fax:845-364-2628
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144448-2207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60176Medicare UPIN