Provider Demographics
NPI:1386849560
Name:JACOBS, NIAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIAMA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 LEXINGTON AVE FL 17
Mailing Address - Street 2:SUITE 1714
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10168-1799
Mailing Address - Country:US
Mailing Address - Phone:401-339-4452
Mailing Address - Fax:
Practice Address - Street 1:380 LEXINGTON AVE FL 17
Practice Address - Street 2:SUITE 1714
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10168-1799
Practice Address - Country:US
Practice Address - Phone:401-339-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2776942084P0800X
NJ25MA092567002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry