Provider Demographics
NPI:1487957569
Name:JOSEPH B. JACOBS, M.D., P.C.
Entity type:Organization
Organization Name:JOSEPH B. JACOBS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-263-7398
Mailing Address - Street 1:345 E 37TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3256
Mailing Address - Country:US
Mailing Address - Phone:646-754-1203
Mailing Address - Fax:646-754-1222
Practice Address - Street 1:345 E 37TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3256
Practice Address - Country:US
Practice Address - Phone:646-754-1203
Practice Address - Fax:646-754-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS044OtherOXFORD
NYCO5541Medicare UPIN