Healthcare Provider Details

I. General information

NPI: 1891613956
Provider Name (Legal Business Name): MADELINE JACOBS CNM
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: MADS JACOBS CNM

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 ABEEL ST FL 1
KINGSTON NY
12401-6739
US

IV. Provider business mailing address

587 ABEEL ST FL 1
KINGSTON NY
12401-6739
US

V. Phone/Fax

Practice location:
  • Phone: 424-502-0669
  • Fax:
Mailing address:
  • Phone: 424-502-0669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002500
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: