Provider Demographics
NPI:1285660225
Name:JACOBS, ARTHUR RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:RUSSELL
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:80 5TH AVE RM 1405
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8002
Mailing Address - Country:US
Mailing Address - Phone:212-614-3282
Mailing Address - Fax:914-244-9143
Practice Address - Street 1:853 BROADWAY
Practice Address - Street 2:1122
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4703
Practice Address - Country:US
Practice Address - Phone:212-614-3282
Practice Address - Fax:914-244-9143
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1207342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08897Medicare UPIN