Provider Demographics
NPI:1447404355
Name:JAKOB, RACHEL (LAC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:JAKOB
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 51ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3316
Mailing Address - Country:US
Mailing Address - Phone:917-685-3878
Mailing Address - Fax:718-435-3677
Practice Address - Street 1:4621 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2414
Practice Address - Country:US
Practice Address - Phone:917-685-3878
Practice Address - Fax:718-435-3677
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003946171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist