Individual
DR. DAVID T JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24 MAPLE AVE STE 2, ROCKVILLE CENTRE, NY 11570-4259
(516) 865-1234
Mailing address
316 EDWARD AVE, WOODMERE, NY 11598-2823
(646) 831-2744
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
257302
NY
208000000X
Pediatrics Physician
XXXXXXX
NY
2085P0229X
Pediatric Radiology Physician
257302
NY
2085R0202X
Diagnostic Radiology Physician
257302
NY
2085R0204X
Vascular & Interventional Radiology Physician
257302
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
257302
NYS LICENSE
NY
Enumeration date
11/22/2009
Last updated
09/20/2018
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