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General NPI Number Information
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NPI Number | 1154194751
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Entity Type | Individual
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Provider Name | BORIS JACOB
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Gender | Male
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 22004 LINDEN BLVD
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City | CAMBRIA HEIGHTS
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State | NY
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Zip | 11411-1628
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Country | US
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Telephone | 718-712-3358
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Fax |
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Provider Business Mailing Address
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Address Line | 441 ROGERS AVE APT 3R
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City | BROOKLYN
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State | NY
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Zip | 11225-3484
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Country | US
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Telephone | 718-541-9199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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