Provider Demographics
NPI:1568789006
Name:MARSH, KETZELA JACOBOWITZ (MD)
Entity Type:Individual
Prefix:
First Name:KETZELA
Middle Name:JACOBOWITZ
Last Name:MARSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KETZELA
Other - Middle Name:LYNN
Other - Last Name:JACOBOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 LAKEVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1123
Mailing Address - Country:US
Mailing Address - Phone:718-470-3480
Mailing Address - Fax:
Practice Address - Street 1:410 LAKEVILLE RD STE 300
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1123
Practice Address - Country:US
Practice Address - Phone:718-470-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN62906207RI0200X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease