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Individual

ALLAN JACOBS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
146-01 45TH AVE, STE 203, FLUSHING, NY 11355
(718) 670-5792
(718) 670-5966
Mailing address
80 MARCUS DR, PROVIDER ENROLLMENT, MELVILLE, NY 11747-4230
(631) 391-8366
(631) 454-4161

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
116843
NY
207VX0201X
Gynecologic Oncology Physician
116843
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01191166
NY
Enumeration date
04/08/2006
Last updated
01/17/2013
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