Provider Demographics
NPI:1841475522
Name:JACOBS, GAIL ELLEN
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ELLEN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1050 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1129
Mailing Address - Country:US
Mailing Address - Phone:516-524-8383
Mailing Address - Fax:516-569-0198
Practice Address - Street 1:1050 FULTON ST
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1129
Practice Address - Country:US
Practice Address - Phone:516-524-8383
Practice Address - Fax:516-569-0198
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016633225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist