Provider Demographics
NPI:1245264357
Name:JACOBS, BERNARD J (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MCMAHON PL
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1700
Mailing Address - Country:US
Mailing Address - Phone:845-628-9595
Mailing Address - Fax:845-628-9597
Practice Address - Street 1:10 MCMAHON PL
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1700
Practice Address - Country:US
Practice Address - Phone:845-628-9595
Practice Address - Fax:845-628-9597
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1002452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
967941Medicare ID - Type Unspecified
D84686Medicare UPIN