Provider Demographics
NPI:1104225119
Name:TEYE, JACOB A (PA-C)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:A
Last Name:TEYE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMORY UNIVERSITY HOSPITAL 1364 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:404-778-5975
Mailing Address - Fax:
Practice Address - Street 1:NEW YORK PRESBYTERIAN QUEENS
Practice Address - Street 2:56-45 MAIN ST FLUSHING
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:347-320-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8577363AM0700X
NY017836363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical