Provider Demographics
NPI:1194843946
Name:JACOBOWITZ, LAURA (COTA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:JACOBOWITZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LEXINGTON HL UNIT 11
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3409
Mailing Address - Country:US
Mailing Address - Phone:914-755-1955
Mailing Address - Fax:
Practice Address - Street 1:WAYNE VIEW
Practice Address - Street 2:2020 RT 23
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-905-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other