Provider Demographics
NPI:1710151584
Name:JACOB, ROSHNEY ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSHNEY
Middle Name:ROSE
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSHNEY
Other - Middle Name:ROSE
Other - Last Name:JACOB-ISSAC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1812 N QUINN ST
Mailing Address - Street 2:APT. #2228
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1338
Mailing Address - Country:US
Mailing Address - Phone:610-931-1587
Mailing Address - Fax:
Practice Address - Street 1:530 1ST AVE STE 5F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-481-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240944207R00000X
DCMD036131207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine