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Individual

ADAM E JACOBSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
739 IRVING AVE, STE 640, SYRACUSE, NY 13210
(315) 464-6255
(315) 464-6251
Mailing address
251 SALINA MEADOWS PKWY, STE 100, SYRACUSE, NY 13212-4516
(315) 464-2000
(315) 464-2010

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
008124
NY
363AS0400X
Surgical Physician Assistant
008124
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02848153
NY
Enumeration date
09/20/2006
Last updated
05/05/2021
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