MEDICARE: RESHMA JACOB DDS, MS

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	1223G0001X	General Practice Dentistry	0401412577	VA
2	1223G0001X	General Practice Dentistry	055895	NY

General Provider Information

NPI Number	:	1982835948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RESHMA JACOB DDS, MS

Provider Business Mailing Address
First Line	:	425 MADISON AVE RM 1800
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-1152
Country	:	US
Telephone Number	:	212-868-4657
Fax Number	:	212-704-8355

Provider Business Practice Location Address
First Line	:	425 MADISON AVE RM 1800
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-1152
Country	:	US
Telephone Number	:	212-868-4657
Fax Number	:	212-704-8355

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

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	07/21/2022

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