Provider Demographics
NPI:1154302537
Name:JACOBS, DAVID SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAMUEL
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WESTAGE BUSINESS CTR DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2260
Mailing Address - Country:US
Mailing Address - Phone:800-835-3723
Mailing Address - Fax:888-847-0818
Practice Address - Street 1:300 WESTAGE BUSINESS CTR DR
Practice Address - Street 2:SUITE 280
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2260
Practice Address - Country:US
Practice Address - Phone:800-835-3723
Practice Address - Fax:888-847-0818
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0611262085N0700X, 2085R0202X
IA353122085N0700X, 2085R0202X
IN01057935A2085N0700X, 2085R0202X
TN398532085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0845741Medicaid
OH0845741Medicaid
OHE99531Medicare UPIN