Provider Demographics
NPI:1053384081
Name:LAJEUNE, JEAN GARRY (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:GARRY
Last Name:LAJEUNE
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 1:745 64TH STREET, 4TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:BROOKLY
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:718-283-8696
Mailing Address - Fax:718-635-7424
Practice Address - Street 1:745 64TH STREET, 4TH FLOOR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-283-8696
Practice Address - Fax:718-635-7424
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227093208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02357880Medicaid
NY02357880Medicaid
H79689Medicare UPIN