Individual
DR. LAURIE G JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MEDICAL ARTS PAVILION, 3400 BAINBRIDGE AVENUE, BRONX, NY 10467
(866) 633-8255
Mailing address
30 PROSPECT AVENUE, HACKENSACK, NJ 07601
(551) 996-2000
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
25MA09916100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0530328
—
NJ
Enumeration date
10/27/2006
Last updated
12/09/2016
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