Provider Demographics
NPI:1720458680
Name:JACOBY, JENNIFER LEE
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:JACOBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 PARSONS BLVD
Mailing Address - Street 2:APT 2
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1047
Mailing Address - Country:US
Mailing Address - Phone:347-570-1761
Mailing Address - Fax:443-390-1127
Practice Address - Street 1:8230 PARSONS BLVD
Practice Address - Street 2:APT 2
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1047
Practice Address - Country:US
Practice Address - Phone:347-570-1761
Practice Address - Fax:443-390-1127
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-04
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency