Healthcare Provider Details

I. General information

NPI: 1174135115
Provider Name (Legal Business Name): JEFFREY JACOBSON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE SUITE 2900 S
HAWTHORNE NY
10532
US

IV. Provider business mailing address

107 N GREELEY AVE # 84
CHAPPAQUA NY
10514
US

V. Phone/Fax

Practice location:
  • Phone: 914-421-0123
  • Fax: 888-381-4542
Mailing address:
  • Phone: 914-421-0123
  • Fax: 888-381-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY JACOBSON
Title or Position: PRESIDENT
Credential: MD
Phone: 914-421-0123