MEDICARE: JACOB ETHAN NEW

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	156F00000X	Technician/Technologist

General Provider Information

NPI Number	:	1811759988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB ETHAN NEW

Provider Business Mailing Address
First Line	:	629 RANDON TER FL 32746
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2636
Country	:	US
Telephone Number	:	321-626-8947
Fax Number	:

Provider Business Practice Location Address
First Line	:	4108 PARK RD STE 205
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2260
Country	:	US
Telephone Number	:	704-248-7557
Fax Number	:

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

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

Similar Medicare Providers

1427563725 — HIFU PROSTATE SERVICES, LLC
Practice Location Address:

4108 PARK RD STE 205
CHARLOTTE, NC
28209-2260

Practice Phone: 704-248-7562
Practice Fax: 866-437-8028

1356534978 — LINDA G. COMBS PH.D.
Practice Location Address:

216 N MCDOWELL ST STE 204
CHARLOTTE, NC
28204-2260

Practice Phone: 704-372-9782
Practice Fax:

1609045335 — S.L. SIMMONS-BOYD, D.D.S., P.A.
Practice Location Address:

725 PROVIDENCE RD , SUITE 301
CHARLOTTE, NC
28207-2260

Practice Phone: 704-376-1696
Practice Fax: 704-376-1698

1932030566 — MR. WENHAO WU MS
Practice Location Address:

1515 MOCKINGBIRD LN STE 700
CHARLOTTE, NC
28209-3236

Practice Phone: 704-541-9628
Practice Fax:

1114858909 — ANDY CASWELL CASWELL
Practice Location Address:

1331 DREXMORE AVE
CHARLOTTE, NC
28209-3016

Practice Phone: 779-252-3390
Practice Fax:

1528999265 — MS. KENNEDY LANGLOIS NCSP, LPES
Practice Location Address:

1606 ABBEY PL UNIT 241
CHARLOTTE, NC
28209-3082

Practice Phone: 704-713-2132
Practice Fax:

Directions to “ JACOB ETHAN NEW ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.