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General NPI Number Information
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NPI Number | 1912090689
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Entity Type | Individual
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Provider Name | EMMANUEL EGIPTO JACOB M.D
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 39 SOUTH RIVER STREET
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City | PLAINS
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State | PA
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Zip | 18705
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Country | US
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Telephone | 570-822-9514
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Fax | 570-823-8039
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Provider Business Mailing Address
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Address Line | 39 SOUTH RIVER STREET
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City | PLAINS
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State | PA
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Zip | 18705
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Country | US
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Telephone | 570-822-9514
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Fax | 570-823-8039
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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 | AK000322L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD026644E
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License Number State | PA
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