Provider Demographics
NPI:1639226145
Name:JOHN J. JACOBS
Entity Type:Organization
Organization Name:JOHN J. JACOBS
Other - Org Name:FEET FIRST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, C-PED
Authorized Official - Phone:585-442-4990
Mailing Address - Street 1:1900 CLINTON AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5621
Mailing Address - Country:US
Mailing Address - Phone:585-442-4990
Mailing Address - Fax:585-442-7169
Practice Address - Street 1:1900 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5621
Practice Address - Country:US
Practice Address - Phone:585-442-4990
Practice Address - Fax:585-442-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPFEET FIRSTOtherMONROE PLAN
NYPFEET FIRSTOtherBLUE CHOICE
NY01356032Medicaid
NYFFI190146OtherBLUE CROSS BLUE SHIELD
NY104442-GDOtherPREFERRED CARE
NYFFI190146OtherBLUE CROSS BLUE SHIELD