Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD066670L | PA |
Y | 2080P0202X | Pediatric Cardiologist | MD066670L | PA |
NPI | 1013939842 |
---|---|
Provider Name | Zev Jacobson |
First Address | Elkins Park, PA 19027-1424 |
Second Address | Elkins Park, PA 19027-1424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001892207 | (05) | PA |
8839905 | (05) | NJ |
H5776 | (02) |