Healthcare Provider Details

I. General information

NPI: 1053467886
Provider Name (Legal Business Name): ELIZABETH LEEF JACOBSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E END AVE
NEW YORK NY
10075-1192
US

IV. Provider business mailing address

2 E END AVE
NEW YORK NY
10075-1192
US

V. Phone/Fax

Practice location:
  • Phone: 917-971-9271
  • Fax: 646-619-4711
Mailing address:
  • Phone: 917-971-9271
  • Fax: 646-619-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number191673
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: