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General NPI Number Information
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NPI Number | 1033356563
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Entity Type | Organization
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Legal Business Name | HILLSIDE MEDICAL & REHABILITATION, PC
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 144-34 HILLSIDE AVE
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City | QUEENS
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State | NY
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Zip | 11435
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Country | US
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Telephone | 718-308-7267
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Fax |
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Provider Business Mailing Address
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Address Line | 3 OAKLEAF CT
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City | HUNTINGTON
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State | NY
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Zip | 11743-6053
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Country | US
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Telephone | 718-308-7267
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIC JACOBSON
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Credential | M.D.
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Telephone | 718-308-7267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 183866-1
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License Number State | NY
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