Provider Demographics
NPI:1205834736
Name:JACOBS, STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HUDSON VALLEY HOSPICE, INC
Mailing Address - Street 2:374 VIOLET AVENUE
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1034
Mailing Address - Country:US
Mailing Address - Phone:845-473-2273
Mailing Address - Fax:845-790-0009
Practice Address - Street 1:HUDSON VALLEY HOSPICE, INC
Practice Address - Street 2:374 VIOLET AVENUE
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1034
Practice Address - Country:US
Practice Address - Phone:845-473-2273
Practice Address - Fax:845-790-0009
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY176467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01386483Medicaid
NYF44464Medicare UPIN
NY01386483Medicaid
NY20L661Medicare PIN