Provider Demographics
NPI:1013087469
Name:GOERTZ, JACOB KREHBIEL (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:KREHBIEL
Last Name:GOERTZ
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 1:235 W 102ND ST
Mailing Address - Street 2:APT. 17N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8400
Mailing Address - Country:US
Mailing Address - Phone:917-842-7003
Mailing Address - Fax:
Practice Address - Street 1:FIRST AVENUE AT 16TH STREET
Practice Address - Street 2:BETH ISRAEL MEDICAL CENTER DEPT. OF EMERGENCY MEDICINE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-420-2847
Practice Address - Fax:212-420-2863
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221907207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02605269Medicaid
A400079390Medicare PIN
NY02605269Medicaid