Provider Demographics
NPI:1396773131
Name:JACOBSON, KIRSTEN E (MD)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:E
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WEST BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477
Mailing Address - Country:US
Mailing Address - Phone:845-246-3000
Mailing Address - Fax:845-246-7622
Practice Address - Street 1:1530 ROUTE 9
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4131
Practice Address - Country:US
Practice Address - Phone:845-297-2511
Practice Address - Fax:845-297-4993
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206698207P00000X
NY206698 1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080164854OtherRAILROAD MEDICARE
6012114OtherMVP
080324000053OtherFIDELIS
123349OtherGHI HMO
0191949OtherGHI
NY01995239Medicaid
9X9381OtherEMPIRE BLUE CROSS
9X9381OtherEMPIRE BLUE CROSS
6012114OtherMVP
NY29C561Medicare ID - Type Unspecified