Provider Demographics
NPI:1508975640
Name:FUTRAN, JACOBO (MD)
Entity Type:Individual
Prefix:
First Name:JACOBO
Middle Name:
Last Name:FUTRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JACOBO
Other - Middle Name:
Other - Last Name:FUTRAN-SHEINBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:970 N BROADWAY
Mailing Address - Street 2:SUITE 312
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1309
Mailing Address - Country:US
Mailing Address - Phone:914-968-4695
Mailing Address - Fax:914-968-2220
Practice Address - Street 1:970 N BROADWAY
Practice Address - Street 2:SUITE 312
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1309
Practice Address - Country:US
Practice Address - Phone:914-968-4695
Practice Address - Fax:914-968-2220
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190461207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01398310Medicaid
NY01398310Medicaid
NYF-73188Medicare UPIN