Provider Demographics
NPI:1871232793
Name:JACOBS, JOHN (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:601 ELMWOOD AVE BOX 670
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:607-301-4141
Mailing Address - Fax:
Practice Address - Street 1:100 JOHN ROEMMELT DR STE 101
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8302
Practice Address - Country:US
Practice Address - Phone:607-739-0352
Practice Address - Fax:607-739-6909
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2024-03-15
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY028495363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant