Basic Information
| Provider Information | |||||||||
| NPI: | 1639224959 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JACOBS | ||||||||
| FirstName: | FRANCINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26666 | ||||||||
| Address2: | PHS PROVIDER ENROLLMENT | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059236770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 82 MIDDLE COUNTRY ROAD | ||||||||
| Address2: | ELSIE OWENS NORTH BROOKHAVEN HEALTH CENTER | ||||||||
| City: | CORAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318542301 | ||||||||
| FaxNumber: | 6318542298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 10/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 227972 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD2010-0581 | NM | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.