Provider Demographics
NPI:1710911730
Name:JAKOBI, ANTOINETTE H (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:H
Last Name:JAKOBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:
Other - Last Name:HERSHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX: PSYCH
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-586-5600
Mailing Address - Fax:585-276-0161
Practice Address - Street 1:10 OFFICE PARK WAY
Practice Address - Street 2:TOBEY VILLAGE OFFICE PARK
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1728
Practice Address - Country:US
Practice Address - Phone:585-586-5600
Practice Address - Fax:585-586-5512
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1935412084P0800X
NY19354112084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101487EWOtherPREFERRED CARE
NYP010193541OtherEXCELLUS BLUE CROSS BLUE
NY01659154Medicaid
NYBB8072Medicare ID - Type Unspecified
NY01659154Medicaid