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Individual

JEFFREY JACOBSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1007 CHAMBERLIN HILL RD EXT, WEST SAND LAKE, NY 12196-2818
(518) 300-9662
Mailing address
1007 CHAMBERLIN HILL RD EXT, WEST SAND LAKE, NY 12196-2818
(518) 300-9662

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
525239035
NY

Other

Enumeration date
03/27/2016
Last updated
03/27/2016
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