Provider Demographics
NPI:1992925341
Name:JACOB, VINITA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:VINITA
Middle Name:ELIZABETH
Last Name:JACOB
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 1:641 5TH AVE APT 38 D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5908
Mailing Address - Country:US
Mailing Address - Phone:917-848-1439
Mailing Address - Fax:
Practice Address - Street 1:1305 YORK AVENUE, 4TH FLOOR
Practice Address - Street 2:DIVISION OF GASTROENTEROLOGY AND HEPATOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-746-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233188207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology