Provider Demographics
NPI:1376348102
Name:JACOB, YEHUDA (EMT-P)
Entity type:Individual
Prefix:MR
First Name:YEHUDA
Middle Name:
Last Name:JACOB
Suffix:
Gender:M
Credentials:EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14433 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3129
Mailing Address - Country:US
Mailing Address - Phone:735-575-7777
Mailing Address - Fax:
Practice Address - Street 1:14433 77TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3129
Practice Address - Country:US
Practice Address - Phone:735-575-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ460705146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic