Individual
ELISSA LEE JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25 WEST ST, TUNKHANNOCK, PA 18657-1405
(570) 996-6200
(570) 996-6201
Mailing address
655 NORTHERN BLVD, SOUTH ABINGTON TOWNSHIP, PA 18411-8740
(570) 842-9323
(570) 842-9362
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT025019
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
PA
Enumeration date
08/25/2017
Last updated
08/25/2017
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