Individual
DR. JORDAN IRA JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
231 E 106TH ST, NEW YORK, NY 10029-4005
(212) 348-0020
(646) 219-2039
Mailing address
231 E 106TH ST, NEW YORK, NY 10029-4005
(212) 348-0020
(646) 219-2039
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
051487
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051487
DENTAL LICENSE
NY
Enumeration date
10/02/2006
Last updated
06/17/2009
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