Healthcare Provider Details

I. General information

NPI: 1457131971
Provider Name (Legal Business Name): JACOB KARBOSKI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 OAK ST
SCRANTON PA
18508-1563
US

IV. Provider business mailing address

459 OAK ST
SCRANTON PA
18508-1563
US

V. Phone/Fax

Practice location:
  • Phone: 272-207-8895
  • Fax:
Mailing address:
  • Phone: 272-207-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064824
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: