Provider Demographics
NPI:1013939842
Name:JACOBSON, ZEV (MD)
Entity Type:Individual
Prefix:
First Name:ZEV
Middle Name:
Last Name:JACOBSON
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 1:205 YORKTOWN PLZ
Mailing Address - Street 2:8120 OLD YORK ROAD
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1424
Mailing Address - Country:US
Mailing Address - Phone:610-616-4138
Mailing Address - Fax:610-471-0416
Practice Address - Street 1:205 YORKTOWN PLZ
Practice Address - Street 2:8120 OLD YORK ROAD
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1424
Practice Address - Country:US
Practice Address - Phone:610-616-4138
Practice Address - Fax:610-471-0416
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066670L208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001892207Medicaid
NJ8839905Medicaid
PA056506Medicare ID - Type Unspecified
H5776Medicare UPIN