Individual
CASEY JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 968-3000
Mailing address
113 TRUXTON RD, DIX HILLS, NY 11746-6827
(631) 972-4952
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
029759
NY
363AM0700X
Medical Physician Assistant
Primary
029759
NY
Other
Enumeration date
03/13/2023
Last updated
05/08/2023
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