Provider Demographics
NPI:1548937808
Name:JACOBO, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JACOBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 SAINT NICHOLAS AVE APT 6M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6203
Mailing Address - Country:US
Mailing Address - Phone:917-640-8999
Mailing Address - Fax:
Practice Address - Street 1:1365 SAINT NICHOLAS AVE APT 6M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6203
Practice Address - Country:US
Practice Address - Phone:917-640-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist