Individual
SUSAN JACOBOWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5865 52ND RD, WOODSIDE, NY 11377-7410
(718) 899-5062
Mailing address
38 BORMAN AVE, STATEN ISLAND, NY 10314-4957
(917) 747-0705
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
213616-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01959508
—
NY
01
—
144SK1
BLUECROSS BLUESHIELD
NY
Enumeration date
02/28/2006
Last updated
07/08/2007
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