Provider Demographics
NPI:1841567567
Name:JAKOB, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:JAKOB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:198 HICKORY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1408
Mailing Address - Country:US
Mailing Address - Phone:917-846-7735
Mailing Address - Fax:
Practice Address - Street 1:5 TEE VIEW CT
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2939
Practice Address - Country:US
Practice Address - Phone:631-874-3032
Practice Address - Fax:631-874-4105
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005913-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist