Provider Demographics
NPI:1245820927
Name:BROWN, JACOB (PA-C)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W JEFFERSON RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1090
Mailing Address - Country:US
Mailing Address - Phone:585-489-5748
Mailing Address - Fax:585-218-0181
Practice Address - Street 1:2300 W JEFFERSON RD STE 400
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1090
Practice Address - Country:US
Practice Address - Phone:585-489-5748
Practice Address - Fax:585-218-0181
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26711363L00000X
NY026711363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner