Provider Demographics
NPI:1942430269
Name:JACOB, HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:JACOB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:601 CHESTNUT ST
Mailing Address - Street 2:APT A19
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2228
Mailing Address - Country:US
Mailing Address - Phone:516-569-6872
Mailing Address - Fax:516-569-6872
Practice Address - Street 1:601 CHESTNUT ST
Practice Address - Street 2:APT A19
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2228
Practice Address - Country:US
Practice Address - Phone:516-569-6872
Practice Address - Fax:516-569-6872
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY136545207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology