Individual
ELIZABETH JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6 WELLNESS WAY STE G03, LATHAM, NY 12110-2135
(518) 785-5884
Mailing address
6 WELLNESS WAY STE 201, LATHAM, NY 12110-2156
(518) 782-3700
(518) 782-3799
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
25MA11829800
NJ
208600000X
Surgery Physician
Primary
298555
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2017
Last updated
09/30/2024
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