Healthcare Provider Details

I. General information

NPI: 1578769550
Provider Name (Legal Business Name): MICHAEL C JACOBELLI, MD, FACS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 LANGHORNE NEWTOWN RD SUITE 106
LANGHORNE PA
19047-1219
US

IV. Provider business mailing address

1205 LANGHORNE NEWTOWN RD SUITE 106
LANGHORNE PA
19047-1219
US

V. Phone/Fax

Practice location:
  • Phone: 215-757-5131
  • Fax: 215-757-5870
Mailing address:
  • Phone: 215-757-5131
  • Fax: 215-757-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: EILEEN ENDERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-757-5131