Individual
JAMES JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
259 1ST ST, MINEOLA, NY 11501-3957
(516) 663-0333
Mailing address
10716 91ST ST, OZONE PARK, NY 11417-1421
(347) 255-5086
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
632221
NY
Other
Enumeration date
09/26/2020
Last updated
09/26/2020
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