Organization
JACOB JACOBY MD
Active
Other names
JACOB JACOBY MD PHD
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB JACOBY MD PHD (OWNER)
(718) 362-8184
Entity
Organization
Contact information
Practice address
100 ROUTE 59 STE 103, SUFFERN, NY 10901-4927
(718) 362-8184
(718) 362-1651
Mailing address
612 CORPORATE WAY STE 2M, VALLEY COTTAGE, NY 10989-2027
(718) 362-8184
(718) 362-1651
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02327411
—
NY
Enumeration date
07/05/2019
Last updated
07/05/2019
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