Mark Nathan Jacobson, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

036139 Issued in NY

Practice address

211 E 43Rd St
#1304
New York, NY 10017-4707

Phone

(212) 697-3946

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144313271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 E 43RD ST",
            "address_2": "#1304",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100174707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 E 43RD ST",
            "address_2": "#1304",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100174707",
            "telephone_number": "212-697-3946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "MARK",
        "middle_name": "NATHAN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "036139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Lee Jacobson, LCSW
• Lawrence David Jacobson, PH.D.
• Leslie Jacobson, M.D.
• Lyn Jacobson, LMSW
• Maria Letizia Jacobson, LMSW
• Michael Jacobson, MD
• Robin Sue Jacobson, MD
• Roseann Jacobson, DIPL.AC.
• Samuel David Jacobson, MD
• Simone Jacobson, MS, CCC-SLP

• Periodontics in New York, NY
• Providers in New York, NY by specialty
• Periodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.