MEDICARE: DR. JENNIFER LOBB M.D.

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	208600000X	Surgery Physician	339819	NY
2	2086S0102X	Surgical Critical Care Physician	339819	NY
3	2086S0127X	Trauma Surgery Physician	339819	NY

General Provider Information

NPI Number	:	1295116861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LOBB M.D.

Provider Business Mailing Address
First Line	:	31 MAIN RD STE 2
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-1953
Country	:	US
Telephone Number	:	631-369-8539
Fax Number	:	631-369-5613

Provider Business Practice Location Address
First Line	:	1 HEROES WAY
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2058
Country	:	US
Telephone Number	:	631-548-6000
Fax Number	:

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

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	11/17/2025

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