Individual
MARYANN PRAKASH JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
79 E POST RD, WHITE PLAINS, NY 10601-5008
(914) 681-1128
Mailing address
79 E POST RD, WHITE PLAINS, NY 10601-5008
(914) 681-1128
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
296270
NY
Other
Enumeration date
04/06/2015
Last updated
10/04/2022
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