Provider Demographics
NPI:1568564979
Name:ROBERT JACOBSON SURGICAL PHARMACY INC.
Entity Type:Organization
Organization Name:ROBERT JACOBSON SURGICAL PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABRAAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GERGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-241-4887
Mailing Address - Street 1:359 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-241-4887
Mailing Address - Fax:914-241-7041
Practice Address - Street 1:359 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-241-4887
Practice Address - Fax:914-241-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017043333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3371159OtherNCPDP
NY00570076Medicaid
3371159OtherNCPDP