Provider Demographics
NPI:1982341368
Name:JACOV, DORIEL
Entity Type:Individual
Prefix:
First Name:DORIEL
Middle Name:
Last Name:JACOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MADISON AVE RM 201
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0816
Mailing Address - Country:US
Mailing Address - Phone:646-389-5801
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE RM 210
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0816
Practice Address - Country:US
Practice Address - Phone:646-389-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker