Provider Demographics
NPI:1013722990
Name:JACOBSEN, MEGHAN VALERIE
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:VALERIE
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 LYON PL
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2494
Mailing Address - Country:US
Mailing Address - Phone:631-317-7737
Mailing Address - Fax:
Practice Address - Street 1:83 LYON PL
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2494
Practice Address - Country:US
Practice Address - Phone:631-317-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist