MEDICARE: BEN Z JACOBS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	168804	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093740300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN Z JACOBS MD

Provider Business Mailing Address
First Line	:	1648 EAST 14TH STREET
Second Line	:	SUITE #2
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1175
Country	:	US
Telephone Number	:	718-336-6886
Fax Number	:	718-336-3945

Provider Business Practice Location Address
First Line	:	1648 EAST 14TH STREET
Second Line	:	SUITE #2
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1175
Country	:	US
Telephone Number	:	718-336-6886
Fax Number	:	718-336-3945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/12/2016

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