Provider Demographics
NPI:1215277678
Name:JACOB, NATHANIEL E (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:E
Last Name:JACOB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASHINGTON ST
Mailing Address - Street 2:LB1
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3147
Mailing Address - Country:US
Mailing Address - Phone:516-483-8383
Mailing Address - Fax:516-483-1116
Practice Address - Street 1:100 WASHINGTON ST
Practice Address - Street 2:LB1
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3147
Practice Address - Country:US
Practice Address - Phone:516-483-8383
Practice Address - Fax:516-483-1116
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0574051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice