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NPI Code Detail

MEDICARE: DR. ERIC JACOBSON MD

MEDICARE: DR. ERIC 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
1208100000XPhysical Medicine & Rehabilitation Physician183866-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12700367OTHERGHI
22I2972OTHERBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1477699692
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC JACOBSON MD
Provider Business Mailing Address
First Line : 3 OAK LEAF COURT
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743
Country : US
Telephone Number : 718-308-6189
Fax Number : 718-884-5002
Provider Business Practice Location Address
First Line : 5822 BROADWAY
Second Line :
City : BRONX
State : NY
Zip : 10463-2454
Country : US
Telephone Number : 718-549-3185
Fax Number : 718-884-5002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 09/05/2010

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