Provider Demographics
NPI:1376323766
Name:IACOBUCCI INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:IACOBUCCI INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:IACOBUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-205-8330
Mailing Address - Street 1:7255 STATE ROUTE 96 STE 210
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9009
Mailing Address - Country:US
Mailing Address - Phone:585-205-8330
Mailing Address - Fax:
Practice Address - Street 1:7255 STATE ROUTE 96 STE 210
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9009
Practice Address - Country:US
Practice Address - Phone:585-205-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty