Provider Demographics
NPI:1023372075
Name:JACOBS, CAROL P
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:P
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SPRING HILL TER
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-7023
Mailing Address - Country:US
Mailing Address - Phone:845-356-2551
Mailing Address - Fax:845-426-1223
Practice Address - Street 1:55 SPRING HILL TER
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-7023
Practice Address - Country:US
Practice Address - Phone:845-356-2551
Practice Address - Fax:845-426-1223
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist