Provider Demographics
NPI:1164638698
Name:JEAN-JACQUES, TREVOR (MD)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:JEAN-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 1:560 PROSPECT PL
Mailing Address - Street 2:APARTMENT 11L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4200
Mailing Address - Country:US
Mailing Address - Phone:347-742-7466
Mailing Address - Fax:
Practice Address - Street 1:560 PROSPECT PL
Practice Address - Street 2:APARTMENT 11L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4200
Practice Address - Country:US
Practice Address - Phone:347-742-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine