Healthcare Provider Details

I. General information

NPI: 1598861510
Provider Name (Legal Business Name): PAMELA J JAKUBOWICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA J SCHUTZER M.D.

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SELWYN AVE
BRONX NY
10457-7626
US

IV. Provider business mailing address

12 WALWORTH AVE
SCARSDALE NY
10583-1418
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-1234
  • Fax:
Mailing address:
  • Phone: 914-472-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number220503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: