Provider Demographics
NPI:1710011929
Name:JACOBSTER, HARRIET B (AUD)
Entity Type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:B
Last Name:JACOBSTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PINE DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6632
Mailing Address - Country:US
Mailing Address - Phone:914-621-2074
Mailing Address - Fax:
Practice Address - Street 1:259 STATE ROUTE 17K STE 103
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8354
Practice Address - Country:US
Practice Address - Phone:845-395-0300
Practice Address - Fax:845-395-0299
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 171400000X, 2255A2300X
NY14000018600237700000X
NY001314231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No171400000XOther Service ProvidersHealth & Wellness Coach
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100053833Medicare Oscar/Certification
NYA400053840Medicare Oscar/Certification