Provider Demographics
NPI:1346388162
Name:JACOB, HARRY S (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:S
Last Name:JACOB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1010 NORTHERN BLVD STE 328
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5329
Mailing Address - Country:US
Mailing Address - Phone:516-233-2484
Mailing Address - Fax:516-304-5850
Practice Address - Street 1:2800 MARCUS AVE STE 203
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1113
Practice Address - Country:US
Practice Address - Phone:516-354-7900
Practice Address - Fax:516-354-7111
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2024-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY112426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C07895Medicare UPIN
NY290281Medicare ID - Type Unspecified