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NPI Code Detail

MEDICARE: MELISSA JACOBS

MEDICARE: MELISSA JACOBS
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
1174400000XSpecialist

General Provider Information

NPI Number : 1588370571
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA JACOBS
Provider Business Mailing Address
First Line : 1 MUSKETT CT
Second Line :
City : BEDFORD
State : NY
Zip : 10506-1714
Country : US
Telephone Number : 914-261-7530
Fax Number :
Provider Business Practice Location Address
First Line : 1311 MAMARONECK AVE
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5221
Country : US
Telephone Number : 914-328-2868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2023
Last Update Date : 01/24/2023

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Directions to “ MELISSA JACOBS ” Practice Location

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