Individual
DR. EDWARD JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 PERRYRIDGE RD, GREENWICH, CT 06830-4607
(203) 869-8353
(203) 869-4004
Mailing address
1 PERRYRIDGE RD, GREENWICH, CT 06830-4607
(203) 869-8353
(203) 869-4004
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22707
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010022707CT02
BLUE CROSS PROVIDER NUMBE
CT
Enumeration date
12/06/2006
Last updated
07/09/2007
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