Provider Demographics
NPI:1942415286
Name:NASSAU PULMONARY & CRITICAL CARE MEDICINE PC
Entity Type:Organization
Organization Name:NASSAU PULMONARY & CRITICAL CARE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-773-6300
Mailing Address - Street 1:891 NORTHERN BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5305
Mailing Address - Country:US
Mailing Address - Phone:516-773-6300
Mailing Address - Fax:516-706-4700
Practice Address - Street 1:891 NORTHERN BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5334
Practice Address - Country:US
Practice Address - Phone:516-773-6300
Practice Address - Fax:516-706-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWQ641Medicare PIN