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Organization
JACOB H JACOBY MEDICAL PC
Active
Organization
JACOB H JACOBY MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB JACOBY MD (CEO)
(845) 697-0000
Entity
Organization
Contact information
Practice address
100 ROUTE 59 STE 103, SUFFERN, NY 10901-4927
(845) 697-0000
(718) 387-6429
Mailing address
100 ROUTE 59 STE 103, SUFFERN, NY 10901-4927
(845) 697-0000
(718) 387-6429
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
NULL
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
103TF0000X
Family Psychologist
—
NULL
103TF0000X
Family Psychologist
—
—
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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