Healthcare Provider Details

I. General information

NPI: 1710803200
Provider Name (Legal Business Name): JACOB MACHSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 HEMPSTEAD TPKE
BETHPAGE NY
11714-5604
US

IV. Provider business mailing address

9 WESTMINSTER RD
SYOSSET NY
11791-6615
US

V. Phone/Fax

Practice location:
  • Phone: 516-862-3358
  • Fax:
Mailing address:
  • Phone: 516-880-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: