# JACOB H JACOBY MEDICAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316597008
- **Authorized official:** JACOB JACOBY MD (CEO)
- **Authorized official phone:** (845) 697-0000

## Contact information

- **Practice address:** 100 ROUTE 59 STE 103, SUFFERN, NY 10901-4927
- **Practice address phone:** (845) 697-0000
- **Practice address fax:** (718) 387-6429
- **Mailing address:** 100 ROUTE 59 STE 103, SUFFERN, NY 10901-4927
- **Mailing address phone:** (845) 697-0000
- **Mailing address fax:** (718) 387-6429

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |
| 103TF0000X | Family Psychologist | — | NULL | — |
| 103TF0000X | Family Psychologist | — | — | — |

## Other

- **Enumeration date:** 09/16/2019
- **Last updated:** 09/16/2019