Provider Demographics
NPI:1801342563
Name:CHAIM A JAKOB DMD, PC
Entity type:Organization
Organization Name:CHAIM A JAKOB DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKOB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-535-3679
Mailing Address - Street 1:501 5TH AVE
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6107
Mailing Address - Country:US
Mailing Address - Phone:212-969-0155
Mailing Address - Fax:
Practice Address - Street 1:501 5TH AVE
Practice Address - Street 2:SUITE 2101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6107
Practice Address - Country:US
Practice Address - Phone:212-969-0155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0576021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty