Provider Demographics
NPI:1316066608
Name:JACOBS, JAMES E (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CENTRAL PARK S
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1628
Mailing Address - Country:US
Mailing Address - Phone:212-371-5250
Mailing Address - Fax:212-371-5311
Practice Address - Street 1:30 CENTRAL PARK S
Practice Address - Street 2:SUITE 2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1628
Practice Address - Country:US
Practice Address - Phone:212-371-5250
Practice Address - Fax:212-371-5311
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034322-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics