Jacob Jacoby MD

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

JACOB JACOBY MD

Practice address

100 Route 59 Ste 103
Suffern, NY 10901-4927

Phone

(718) 362-8184

Fax

(718) 362-1651

NPI assigned

Jul 5, 2019

Organization subpart

No

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

Authorized official

Name

Jacob Jacoby, MD PHDNPI 1174648232

Title

Owner

Phone

(718) 362-8184

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• JACOB JACOBY MD PHD Doing business as

Practitioners 1

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

• Jacob H Jacoby, MD PHD

  • Psychiatry Physician
  • Bayonne, NJ
  • NPI 1174648232
  NPD Authorized official

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

{
    "created_epoch": "1562284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562284800000",
    "number": "1790347243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 CORPORATE WAY STE 2M",
            "city": "VALLEY COTTAGE",
            "state": "NY",
            "postal_code": "109892027",
            "telephone_number": "718-362-8184",
            "fax_number": "718-362-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ROUTE 59 STE 103",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109014927",
            "telephone_number": "718-362-8184",
            "fax_number": "718-362-1651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOB JACOBY MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-05",
        "last_updated": "2019-07-05",
        "status": "A",
        "authorized_official_last_name": "JACOBY",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-362-8184",
        "authorized_official_credential": "MD PHD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02327411",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACOB JACOBY MD PHD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rachel Itkowitz, LMT
• J&D Ultracare Corp
• Cynthia Jackson, RN
• J'Nai Jackson, LPN
• Jacob H Jacoby Medical PC
• James Jacob, PHARM.D.
• Kadian Marie Jacobs, LPN
• Elisheva Chana Jacobson, OTR/L
• Elisheva Jakobov, PSYD
• James B. Israel, M.D., P.C.

• All providers in Suffern, NY
• Multi-Specialty Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.