Individual
JERRY JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
333 ROUTE 25A, SUITE 225, ROCKY POINT, NY 11778-8556
(631) 744-3671
(631) 744-6205
Mailing address
333 ROUTE 25A, SUITE 225, ROCKY POINT, NY 11778-8556
(631) 744-3671
(631) 744-6205
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
573032
NY
367500000X
Certified Registered Nurse Anesthetist
105943
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN9384865
FL
Other
Enumeration date
05/22/2014
Last updated
05/29/2025
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