Provider Demographics
NPI:1790879005
Name:IACOB, CODRIN EUGEN (MD)
Entity Type:Individual
Prefix:
First Name:CODRIN
Middle Name:EUGEN
Last Name:IACOB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1279
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8948
Mailing Address - Country:US
Mailing Address - Phone:212-979-4156
Mailing Address - Fax:212-677-1284
Practice Address - Street 1:310 E 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4201
Practice Address - Country:US
Practice Address - Phone:212-979-4156
Practice Address - Fax:212-677-1284
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236911207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56R081Medicare PIN
I02815Medicare UPIN