Provider Demographics
NPI:1902265945
Name:JACOBS-FRIEDMAN, ALON BRACHYA
Entity Type:Individual
Prefix:MR
First Name:ALON
Middle Name:BRACHYA
Last Name:JACOBS-FRIEDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALON
Other - Middle Name:BRACHYA
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:47 NEW SCOTLAND AVE # MC48
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:MC 48
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-262-0923
Practice Address - Fax:518-262-6470
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340368363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily