Provider Demographics
NPI:1861912321
Name:JASINSKI, JACOB MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:MICHAEL
Last Name:JASINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAKE
Other - Middle Name:MICHAEL
Other - Last Name:JASINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:834 CHESTNUT ST APT 1605
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5148
Mailing Address - Country:US
Mailing Address - Phone:954-448-3105
Mailing Address - Fax:
Practice Address - Street 1:909 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5211
Practice Address - Country:US
Practice Address - Phone:215-955-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023355207T00000X
PAOS023856207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery