MEDICARE: DR. DAVID JAKUBOWITZ 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	050068	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	:	1326184771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JAKUBOWITZ DDS

Provider Business Mailing Address
First Line	:	564 CHURCH AVE
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598
Country	:	US
Telephone Number	:	516-791-1175
Fax Number	:	718-821-7519

Provider Business Practice Location Address
First Line	:	6835 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7234
Country	:	US
Telephone Number	:	718-821-0170
Fax Number	:	718-821-7519

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/28/2010

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