Provider Demographics
NPI:1386619443
Name:SHARABY, JACOB S (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:S
Last Name:SHARABY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2289 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5146
Mailing Address - Country:US
Mailing Address - Phone:718-382-1494
Mailing Address - Fax:
Practice Address - Street 1:770 OCEAN PKWY
Practice Address - Street 2:SUITE 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2184
Practice Address - Country:US
Practice Address - Phone:718-941-2002
Practice Address - Fax:718-287-7719
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195122174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02006917Medicaid
NYF83422Medicare UPIN
NY20J19EZ681Medicare UPIN
NY02006917Medicaid