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General NPI Number Information
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NPI Number | 1467723205
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Entity Type | Individual
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Provider Name | JEFFREY H JACOB
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Gender | Male
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 2039 PALMER AVE STE 203
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City | LARCHMONT
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State | NY
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Zip | 10538-2483
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Country | US
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Telephone | 212-812-0788
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Fax |
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Provider Business Mailing Address
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Address Line | 29 CAPE MAY DR
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City | MARLBORO
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State | NJ
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Zip | 07746-2618
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Country | US
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Telephone | 212-812-0788
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000683-1
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License Number State | NY
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