Basic Information
| Provider Information | |||||||||
| NPI: | 1598831349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAURICE | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | RONEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 E LINCOLN AVE APT 401 | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105523514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146676661 | ||||||||
| FaxNumber: | 9146676661 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 E 149TH ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795000 | ||||||||
| FaxNumber: | 7185795028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 221776 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.