Healthcare Provider Details

I. General information

NPI: 1902849664
Provider Name (Legal Business Name): JACOB SOSNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE BETH ISRAEL DEACONESS MEDICAL CENTER
BOSTON MA
02215
US

IV. Provider business mailing address

30 HEASIS ST APT 6
RISHON LE-ZION ISRAEL
74592
IL

V. Phone/Fax

Practice location:
  • Phone: 617-754-2519
  • Fax:
Mailing address:
  • Phone: 97226776901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number219821
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: