Individual
DIANNA ELIZABETH JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-2451
Mailing address
227 E 89TH ST, APT 4A, NEW YORK, NY 10128-4382
(917) 747-0048
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
007635
NY
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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