Provider Demographics
NPI:1649836511
Name:JOSEPHEENA JACOB MD PC
Entity type:Organization
Organization Name:JOSEPHEENA JACOB MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-328-3700
Mailing Address - Street 1:274 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2107
Mailing Address - Country:US
Mailing Address - Phone:516-328-3700
Mailing Address - Fax:516-328-3767
Practice Address - Street 1:274 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2107
Practice Address - Country:US
Practice Address - Phone:516-328-3700
Practice Address - Fax:516-328-3767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty