Healthcare Provider Details

I. General information

NPI: 1588812820
Provider Name (Legal Business Name): JEFFREY MICA JACOBSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2008
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 Number264192
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number264192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: