Provider Demographics
NPI:1558486217
Name:JACOBS, MICHELLE (RPA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:RABITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:301 E 17TH ST
Mailing Address - Street 2:SUITE 204 A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3804
Mailing Address - Country:US
Mailing Address - Phone:646-346-3887
Mailing Address - Fax:
Practice Address - Street 1:301 E 17TH ST
Practice Address - Street 2:SUITE 204 C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-598-2337
Practice Address - Fax:212-598-2333
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant