# JUDD JACOB

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1407152333
- **Gender:** Man
- **Credential:** PT, CLS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 032031 | NY | — |
| 247ZC0005X | Clinical Laboratory Director (Non-physician) | 014999 | NY | Yes |
| 247ZC0005X | Clinical Laboratory Director (Non-physician) | 226448 | NULL | — |

## Other

- **Enumeration date:** 02/10/2011
- **Last updated:** 04/13/2016