SHANE SAJI JACOB

ELMHURST, NY
NPI1609484468
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: NY  025732)
Additional Taxonomies363A00000X Physician Assistant
Enumeration Date2020-07-17
Last Update Date2021-02-26
Business Address
Mr. SHANE SAJI JACOB PA
7901 BROADWAY
ELMHURST, NY 11373-1329
Phone number: 718-334-2480
Mailing Address
Mr. SHANE SAJI JACOB PA
7901 BROADWAY
ELMHURST, NY 11373-1329
Phone number: 718-334-2480
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