Healthcare Provider Details

I. General information

NPI: 1346362894
Provider Name (Legal Business Name): DONALD JAMES JACOB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 TRANSIT RD SUITE 6
EAST AMHERST NY
14051-2606
US

IV. Provider business mailing address

8169 OAK LEAF LN
WILLIAMSVILLE NY
14221-2856
US

V. Phone/Fax

Practice location:
  • Phone: 716-688-6161
  • Fax: 716-636-5084
Mailing address:
  • Phone: 716-639-8011
  • Fax: 716-639-7590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number176605
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number176605
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number176605-4B
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: