Individual
DR. JOHN RUSSELL JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
14 ACORN DR, EAST NORTHPORT, NY 11731-1302
(631) 754-5892
Mailing address
14 ACORN DR, EAST NORTHPORT, NY 11731-1302
(631) 754-5892
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
008596-1
NY
Other
Enumeration date
02/26/2007
Last updated
07/09/2007
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