Individual
JOHN A JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
100 JOHN ROEMMELT DR, SUITE 202, HORSEHEADS, NY 14845-8301
(607) 795-2820
(607) 795-2821
Mailing address
571 SAINT JOSEPHS BLVD FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000610-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03576318
—
NY
05
—
103046786
—
PA
Enumeration date
08/26/2008
Last updated
06/13/2016
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