Provider Demographics
NPI:1801803556
Name:JACOBSON, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 NORTH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2232
Mailing Address - Country:US
Mailing Address - Phone:914-949-1244
Mailing Address - Fax:914-684-1336
Practice Address - Street 1:311 NORTH ST STE 202
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2232
Practice Address - Country:US
Practice Address - Phone:914-949-1244
Practice Address - Fax:914-684-1336
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000106418OtherGHI HMO
200250001OtherAARP
3C3753OtherHEALTHNET
7671168OtherAETNA
NYP3069321OtherOXFORD
1998552OtherUNITED HEALTHCARE
200250001OtherPOMCO
200250001OtherCIGNA
2884796OtherAETNA
NY5294A1OtherEMPIRE BCBS
5996989OtherGHI
NY02105824Medicaid
NY5294A1OtherEMPIRE BCBS
3C3753OtherHEALTHNET