MEDICARE: DR. ALAN ROY JACOBS M.D.

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	2084N0400X	Neurology Physician	183799	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	183799	OTHER	NY	MEDICAL LICENSE

General Provider Information

NPI Number	:	1689641276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN ROY JACOBS M.D.

Provider Business Mailing Address
First Line	:	14 WAPPINGER TRL
Second Line	:
City	:	BRIARCLIFF MANOR
State	:	NY
Zip	:	10510-1950
Country	:	US
Telephone Number	:	914-747-1962
Fax Number	:	914-747-1962

Provider Business Practice Location Address
First Line	:	120 E 56TH ST
Second Line	:	SUITE 1040
City	:	NEW YORK
State	:	NY
Zip	:	10022-3607
Country	:	US
Telephone Number	:	212-888-0002
Fax Number	:	212-888-1899

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/08/2007

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