Healthcare Provider Details

I. General information

NPI: 1538132634
Provider Name (Legal Business Name): ALEXANDER YACOBSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 THWAITES PL
BRONX NY
10467-7947
US

IV. Provider business mailing address

11 PELL PL
PELHAM NY
10803-1309
US

V. Phone/Fax

Practice location:
  • Phone: 914-738-6435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number005271
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number005271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: