Individual
MARK NATHAN JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
211 E 43RD ST, #1304, NEW YORK, NY 10017-4707
(212) 697-3946
Mailing address
211 E 43RD ST, #1304, NEW YORK, NY 10017-4707
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
036139
NY
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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