Provider Demographics
NPI:1700050556
Name:NEW YORK NEUROSURGICAL PLLC
Entity Type:Organization
Organization Name:NEW YORK NEUROSURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:845-896-9200
Mailing Address - Street 1:4 LAFAYETTE CT
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3036
Mailing Address - Country:US
Mailing Address - Phone:845-896-9200
Mailing Address - Fax:845-896-3262
Practice Address - Street 1:4 LAFAYETTE CT
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3036
Practice Address - Country:US
Practice Address - Phone:845-896-9200
Practice Address - Fax:845-896-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
60-170107207T00000X
NY170107207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60100Medicare UPIN
NY17K961Medicare PIN
NY17R961Medicare PIN