1699855106 NPI number — MRS. JEANNE MARIE JACOBY FNP

Table of content: MRS. JEANNE MARIE JACOBY FNP (NPI 1699855106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699855106 NPI number — MRS. JEANNE MARIE JACOBY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBY
Provider First Name:
JEANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RESTIVO
Provider Other First Name:
JEANNE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699855106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 MALL RD
Provider Second Line Business Mailing Address:
LAHEY CLINIC
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01805-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-744-7000
Provider Business Mailing Address Fax Number:
781-744-5348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 MALL RD
Provider Second Line Business Practice Location Address:
LAHEY HOSPITAL & MEDICAL CENTER
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01805-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-744-7000
Provider Business Practice Location Address Fax Number:
781-744-5348
Provider Enumeration Date:
10/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  055219-23-03 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN260920 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110084016A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".