Provider Demographics
NPI:1891031944
Name:JAKUBOVICS, SIDNEY JAY (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:JAY
Last Name:JAKUBOVICS
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 1:411 FELTER AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1143
Mailing Address - Country:US
Mailing Address - Phone:516-374-2517
Mailing Address - Fax:212-499-4931
Practice Address - Street 1:411 FELTER AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1143
Practice Address - Country:US
Practice Address - Phone:516-374-2517
Practice Address - Fax:212-499-4931
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD116392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine