Jose R Etienne, PA-C is a medicare enrolled "Physician Assistant" in Laurelton, New York. His current practice location is
130-17 221 Street, Laurelton, New York. You can reach out to his office (for appointments etc.) via phone at
(718) 775-7765.
Jose R Etienne is licensed to practice in New York (license number 018374) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1407245558.
Provider's Profile
| Full Name | Jose R Etienne |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Location | 130-17 221 Street, Laurelton, New York |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1407245558
- Provider Enumeration Date: 01/13/2015
- Last Update Date: 09/27/2016
Medicare PECOS Information:
- PECOS PAC ID: 2668792177
- Enrollment ID: I20161229001370
Medical Identifiers
Medical identifiers for Jose R Etienne such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1407245558 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | 018374 (New York) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jose R Etienne is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jose R Etienne, PA-C
5555 Glenridge Connector, Ste 700,
Atlanta, GA 30342-4758
Ph: (678) 956-6531 | Jose R Etienne, PA-C
130-17 221 Street,
Laurelton, NY 11413
Ph: (718) 775-7765 |
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