Individual
JENNIFER SUSAN JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 662-3807
Mailing address
8036 264TH ST, FLORAL PARK, NY 11004-1523
(347) 982-5751
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA062473
PA
Other
Enumeration date
04/22/2021
Last updated
04/22/2021
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