Provider Demographics
NPI:1235608035
Name:EASTERN MEDICAL CONSULTING PC
Entity Type:Organization
Organization Name:EASTERN MEDICAL CONSULTING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:347-744-8605
Mailing Address - Street 1:25 WILLET AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1637
Mailing Address - Country:US
Mailing Address - Phone:347-744-8605
Mailing Address - Fax:516-935-3140
Practice Address - Street 1:330 W 58TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1827
Practice Address - Country:US
Practice Address - Phone:212-765-6470
Practice Address - Fax:212-333-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty