MEDICARE: LAWRENCE MARC JACOBSON 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	207W00000X	Ophthalmology Physician	191576	NY

General Provider Information

NPI Number	:	1184627465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE MARC JACOBSON MD

Provider Business Mailing Address
First Line	:	128 LEE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-8417
Country	:	US
Telephone Number	:	212-981-9812
Fax Number	:	212-981-9813

Provider Business Practice Location Address
First Line	:	128 LEE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-8417
Country	:	US
Telephone Number	:	212-981-9812
Fax Number	:	212-981-9813

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/29/2025

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