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General NPI Number Information
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NPI Number | 1942405246
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Entity Type | Organization
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Legal Business Name | LAWRENCE M. JACOBY, M.D., PC
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 18 W AVON RD
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City | AVON
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State | CT
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Zip | 06001-3583
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Country | US
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Telephone | 860-673-1667
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Fax | 860-673-1544
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Provider Business Mailing Address
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Address Line | 18 W AVON RD
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City | AVON
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State | CT
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Zip | 06001-3583
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Country | US
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Telephone | 860-673-1667
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Fax | 860-673-1544
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JODIE JACOBY
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Credential |
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Telephone | 860-673-1667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 016756
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License Number State | CT
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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 | 022522
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 000178
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License Number State | CT
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