| NPI | 1851690788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA R JACOB Physcian/Owner Solo LLC Practice 516-488-8145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: NY 161044) |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2011-03-17 |