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General NPI Number Information
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NPI Number | 1366540528
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Entity Type | Individual
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Provider Name | STANLEY JACOB MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 180 PHILLIPS HILL RD SUITE 4A
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City | NEW CITY
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State | NY
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Zip | 10956-4132
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Country | US
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Telephone | 845-499-2339
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Fax | 845-499-2340
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Provider Business Mailing Address
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Address Line | 147 PRIMROSE DR
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2115
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Country | US
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Telephone | 718-490-1280
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 241646
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License Number State | NY
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