Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS 015988 | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | 2011-00649 | NC |
Y | 207QS0010X | Family Doctor - Sports Medicine | 280667-1 | NY |
NPI | 1043478795 |
---|---|
Provider Name | Dr. Bret Charles Jacobs |
First Address | New York, NY 10001-5105 |
Second Address | New York, NY 10017-6145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 20/12/2019 |