Provider Demographics
NPI:1750415527
Name:JACOBY, SIDNEY M (MD)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:M
Last Name:JACOBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 PULASKI DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2802
Mailing Address - Country:US
Mailing Address - Phone:610-768-5940
Mailing Address - Fax:610-768-5947
Practice Address - Street 1:950 PULASKI DR STE 100
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2802
Practice Address - Country:US
Practice Address - Phone:610-768-5940
Practice Address - Fax:610-768-5947
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08447300207X00000X
PAMD427065207X00000X, 207XS0106X
NJ25MA084473000207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2106499OtherPENNSYLVANIA BLUE SHIELD
PA3722652000OtherINDEPENDENCE BLUE CROSS - PERSONAL CHOICE
PA3722652000OtherKEYSTONE HEALTH PLAN EAST
PA162810GC4Medicare PIN