MEDICARE: DR. CAROLYN YVETTE 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	208000000X	Pediatrics Physician	225602	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	:	1306825575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN YVETTE JACOBS MD

Provider Business Mailing Address
First Line	:	1425 PORTLAND AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-3001
Country	:	US
Telephone Number	:	585-922-2575
Fax Number	:	585-922-5033

Provider Business Practice Location Address
First Line	:	1425 PORTLAND AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-3001
Country	:	US
Telephone Number	:	585-922-2575
Fax Number	:	585-922-5033

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	03/23/2023

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