Provider Demographics
NPI:1700818945
Name:IACOBUCCI, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:IACOBUCCI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2400 CLINTON AVE S BLDG F
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2668
Mailing Address - Country:US
Mailing Address - Phone:585-241-9910
Mailing Address - Fax:585-256-3204
Practice Address - Street 1:7255 STATE ROUTE 96 STE 210
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9009
Practice Address - Country:US
Practice Address - Phone:585-505-6341
Practice Address - Fax:833-450-0134
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-02-15
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Provider Licenses
StateLicense IDTaxonomies
NY208826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01954952Medicaid
NYBB6243Medicare PIN