Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 157834 | NY |
NPI | 1164519120 |
---|---|
Provider Name | Dr. Ronald Irwin Jacobson |
First Address | Sleepy Hollow, NY 10591 |
Second Address | Sleepy Hollow, NY 10591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 18/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00854357 | (05) | NY |
A61368 | (02) |