Jacobs Radiology PLLC

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

Legal business name

JACOBS RADIOLOGY PLLC

Practice address

24 Maple Ave Ste 2
Rockville Centre, NY 11570-4259

Phone

(516) 865-1234

NPI assigned

Apr 26, 2017

Organization subpart

No

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

Authorized official

Name

David T Jacobs, MDNPI 1811225394

Title

Owner

Phone

(516) 865-1234

Specialties & licenses 2

Addresses

Other names 1

• South Shore Vein and Image-Guided Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David T Jacobs, MD

  • Phlebology Physician
  • Rockville Centre, NY
  • NPI 1811225394

  Single Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1493164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609372800000",
    "number": "1255866372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 MAPLE AVE STE 2",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115704259",
            "telephone_number": "516-865-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 MAPLE AVE STE 2",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115704259",
            "telephone_number": "516-865-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBS RADIOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-26",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-865-1234",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Phlebology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "257302-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Shore Vein and Image-Guided Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jay Itzkowitz, MD
• Asif Jabar
• Muataz Jaber, MD
• Kim Rene Jackman
• Noreen Jackson-Iacobellis, MS-CCC, SLP
• Bradford Elliot Jacobs, PH.D.
• David T Jacobs, MD
• Donn R Jacobs, DDS
• Steven Andrew Jacobs, D.O.
• Andrew Gene Jacobson, D.M.D.

• Phlebology Physician in Rockville Centre, NY
• Providers in Rockville Centre, NY by specialty
• Phlebology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.