Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 218283 | NY |
NPI | 1003016411 |
---|---|
Provider Name | Dr. Amanda Mcnear Jacobs |
First Address | Bronx, NY 10467 |
Second Address | Bronx, NY 10467-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 12/10/2011 |