MEDICARE: SHOSHANA JAKUBOVICS

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	235Z00000X	Speech-Language Pathologist	019831	NY

General Provider Information

NPI Number	:	1467995837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOSHANA JAKUBOVICS

Provider Business Mailing Address
First Line	:	227 STERLING PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 STERLING PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4904
Country	:	US
Telephone Number	:	718-857-5516
Fax Number	:

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

Provider Enumeration Date	:	12/02/2016
Last Update Date	:	11/01/2017

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Directions to “ SHOSHANA JAKUBOVICS ” Practice Location

Language	Start Address	Practice Location

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