Healthcare Provider Details

I. General information

NPI: 1811260755
Provider Name (Legal Business Name): CHANI JACOBOWITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SUNSET RD
LAWRENCE NY
11559-1422
US

IV. Provider business mailing address

1 SUNSET RD
LAWRENCE NY
11559-1422
US

V. Phone/Fax

Practice location:
  • Phone: 718-787-1100
  • Fax: 718-787-9598
Mailing address:
  • Phone: 718-787-1100
  • Fax: 718-787-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number082650
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: