MEDICARE: AMARILIS JACOBO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	45577-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265418008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMARILIS JACOBO DDS

Provider Business Mailing Address
First Line	:	131 W 110TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026-4202
Country	:	US
Telephone Number	:	212-678-1944
Fax Number	:	121-666-6857

Provider Business Practice Location Address
First Line	:	131 W 110TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026-4202
Country	:	US
Telephone Number	:	212-678-1944
Fax Number	:	121-666-6857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	05/26/2021

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