Individual
ALICE JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1038 LLOYD ST, FRANKLIN SQUARE, NY 11010-2832
(845) 857-8217
Mailing address
1038 LLOYD ST, FRANKLIN SQUARE, NY 11010-2832
(845) 857-8217
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
259989
NY
Other
Enumeration date
03/28/2019
Last updated
03/28/2019
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