Provider Demographics
NPI:1447412119
Name:JEANTY, DARLY C (MD)
Entity type:Individual
Prefix:MR
First Name:DARLY
Middle Name:C
Last Name:JEANTY
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 1:185 BIRCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563
Mailing Address - Country:US
Mailing Address - Phone:845-878-4507
Mailing Address - Fax:
Practice Address - Street 1:185 BIRCH HILL RD
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563
Practice Address - Country:US
Practice Address - Phone:845-878-4507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111751208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice