Healthcare Provider Details

I. General information

NPI: 1487164885
Provider Name (Legal Business Name): JODI JACOBS DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 WHITE PLAINS RD
BRONX NY
10467-5704
US

IV. Provider business mailing address

10 GLADSTONE PL
YONKERS NY
10703-1149
US

V. Phone/Fax

Practice location:
  • Phone: 718-325-1658
  • Fax: 718-653-1658
Mailing address:
  • Phone: 914-623-8722
  • Fax: 914-476-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number011379
License Number StateNY

VIII. Authorized Official

Name: DR. JODI L JACOBS
Title or Position: OWNER/OPERATOR
Credential: DC
Phone: 914-476-6500