Provider Demographics
NPI:1982740106
Name:ERIC JACOBSON MD PC
Entity Type:Organization
Organization Name:ERIC JACOBSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-717-9963
Mailing Address - Street 1:3 OAKLEAF COURT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:718-717-9963
Mailing Address - Fax:718-225-1941
Practice Address - Street 1:19402 NORTHERN BLVD
Practice Address - Street 2:STE 205
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-717-9963
Practice Address - Fax:718-225-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F68913Medicare UPIN
02012GMedicare ID - Type UnspecifiedINDIVIDUAL
02012Medicare ID - Type UnspecifiedGROUP