Provider Demographics
NPI:1194090936
Name:JACOBSOHN, CLAIRE (PT)
Entity type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:
Last Name:JACOBSOHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SINTSINK DR W
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2047
Mailing Address - Country:US
Mailing Address - Phone:646-715-8534
Mailing Address - Fax:
Practice Address - Street 1:5740 MARATHON PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2036
Practice Address - Country:US
Practice Address - Phone:718-423-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010602-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist