MEDICARE: ALEXANDER YACOBSON

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	174400000X	Specialist	005271
2	213E00000X	Podiatrist	005271	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	:	1538132634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER YACOBSON

Provider Business Mailing Address
First Line	:	11 PELL PL
Second Line	:
City	:	PELHAM
State	:	NY
Zip	:	10803-1309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 THWAITES PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-7947
Country	:	US
Telephone Number	:	914-738-6435
Fax Number	:

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	09/30/2025

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