Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 294893 | NY |
N | 111NI0900X | Internist | 294893 | NY |
Y | 207RA0401X | Internist - Addiction Medicine | 294893 | NY |
NPI | 1366820185 |
---|---|
Provider Name | Andrea Jakubowski |
First Address | Saint Cloud, MN 56303-0431 |
Second Address | Bronx, NY 10467-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2015 |
Last Update Date | 08/02/2022 |