Provider Demographics
NPI:1639224959
Name:JACOBS, FRANCINE (MD)
Entity type:Individual
Prefix:
First Name:FRANCINE
Middle Name:
Last Name:JACOBS
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:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:
Practice Address - Street 1:82 MIDDLE COUNTRY ROAD
Practice Address - Street 2:ELSIE OWENS NORTH BROOKHAVEN HEALTH CENTER
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727
Practice Address - Country:US
Practice Address - Phone:631-854-2301
Practice Address - Fax:631-854-2298
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227972208000000X
NMMD2010-0581208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100166Medicare UPIN
NY85X110Medicare ID - Type Unspecified