Provider Demographics
NPI:1861818650
Name:JACOBI, MICHAEL YAKUBOV (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:YAKUBOV
Last Name:JACOBI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8335 139TH ST
Mailing Address - Street 2:APT 1R
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1600
Mailing Address - Country:US
Mailing Address - Phone:917-254-8854
Mailing Address - Fax:509-351-8279
Practice Address - Street 1:8335 139TH ST
Practice Address - Street 2:APT 1R
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1600
Practice Address - Country:US
Practice Address - Phone:917-254-8854
Practice Address - Fax:509-351-8279
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY274080208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice