Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 233263 | NY |
Y | 207R00000X | Internist | 233263 | NY |
Y | 111NI0900X | Internist | 233263 | NY |
NPI | 1275575920 |
---|---|
Provider Name | Christopher Jacobus |
First Address | Cheektowaga, NY 14227-1416 |
Second Address | Cheektowaga, NY 14227-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 18/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0107182 | (05) | NY |
H24033 | (02) | NY |