Provider Demographics
NPI:1700542073
Name:JACOBS, MARGARET ESTHER
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ESTHER
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:230 BAYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-2017
Mailing Address - Country:US
Mailing Address - Phone:516-801-2056
Mailing Address - Fax:
Practice Address - Street 1:708 GLEN COVE AVE STE 202
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1655
Practice Address - Country:US
Practice Address - Phone:516-669-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00239225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist