Individual
KIM MOON JA JACOBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BS
Contact information
Practice address
6 EUCLID AVE, CORTLAND, NY 13045-1257
(914) 433-3338
Mailing address
800 MACBEAN LN, CORTLAND, NY 13045-9310
(914) 433-3338
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
467366-01
NY
Other
Enumeration date
07/23/2024
Last updated
08/08/2024
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