Provider Demographics
NPI:1710989165
Name:JAKUBOWSKI, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:JAKUBOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY127951-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10000968OtherCDPHP
110160500OtherUS DEPT OF LABOR
31305OtherEMPIRE BLUE CROSS
MJ03130510OtherEMPIRE BLUE CROSS
000405006001OtherBLUE SHIELD NENY
MJ03130520OtherEMPIRE BLUE CROSS
CAN1279512OtherNO FAULT
000000081679OtherGHI HMO
NY00392810Medicaid
040426006659OtherFIDELIS
05106OtherMVP
33570KOtherFIDELIS MEDICARE
127951-1OtherTRICARE NORTH REGION
CAN1279512OtherWORKERS COMP
9704570OtherGHI
B18637OtherAMERICAN PROGRESSIVE TODA
000405006002OtherBLUE SHIELD NENY
MJ03130510OtherEMPIRE BLUE CROSS
000000081679OtherGHI HMO
CAN1279512OtherNO FAULT