Provider Demographics
NPI:1700062999
Name:JACOBS, LOUIS W (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:W
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:4240 HUTCHINSON RIVER PKWY E
Mailing Address - Street 2:4240 HUTCHINSON RIVER PKWY EAST
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4746
Mailing Address - Country:US
Mailing Address - Phone:718-671-2233
Mailing Address - Fax:718-671-2323
Practice Address - Street 1:4240 HUTCHINSON RIVER PKWY E
Practice Address - Street 2:4240 HUTCHINSON RIVER PKWY EAST
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4746
Practice Address - Country:US
Practice Address - Phone:718-671-2233
Practice Address - Fax:718-671-2323
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2380213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00413438Medicaid
NYT50758Medicare UPIN
NYP2721ZT3W1Medicare PIN