Healthcare Provider Details

I. General information

NPI: 1972434041
Provider Name (Legal Business Name): JACOB TINKOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 LOISDALE RD STE 106
SPRINGFIELD VA
22150-1815
US

IV. Provider business mailing address

3011 TAYLOR MAKENZYE CT
HERNDON VA
20171-4074
US

V. Phone/Fax

Practice location:
  • Phone: 703-888-3425
  • Fax:
Mailing address:
  • Phone: 703-344-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101003005
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: