Provider Demographics
NPI:1396711040
Name:JACOBS, TIKVA (MD)
Entity type:Individual
Prefix:
First Name:TIKVA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 70TH ST FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-9800
Mailing Address - Country:US
Mailing Address - Phone:646-962-8450
Mailing Address - Fax:646-962-0323
Practice Address - Street 1:520 E 70TH ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9800
Practice Address - Country:US
Practice Address - Phone:646-962-8450
Practice Address - Fax:646-962-0323
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2149172086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02647923Medicaid
NY02647923Medicaid
I30079Medicare UPIN