Provider Demographics
NPI:1902046345
Name:JACOBS, SHARON G (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:G
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:GAIL
Other - Last Name:JACOBS-KRASHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 W 72ND ST APT 34
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3418
Mailing Address - Country:US
Mailing Address - Phone:212-308-0948
Mailing Address - Fax:212-308-4212
Practice Address - Street 1:1 W 72ND ST APT 34
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3418
Practice Address - Country:US
Practice Address - Phone:212-308-0948
Practice Address - Fax:212-333-0842
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-1300081744R1103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60-130008OtherLICENSE #