Individual
LISA J JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MPH
Contact information
Practice address
462 GRIDER ST, BUFFALO, NY 14215-3021
(716) 898-3000
Mailing address
908 NIAGARA FALLS BLVD STE 208, NORTH TONAWANDA, NY 14120-2019
(716) 692-3302
(716) 692-4342
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
285489
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04497090
—
NY
05
—
3141446
—
MA
Enumeration date
12/16/2005
Last updated
10/11/2017
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