1396773131 NPI number — DR. KIRSTEN E JACOBSON MD

Table of content: DR. KIRSTEN E JACOBSON MD (NPI 1396773131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396773131 NPI number — DR. KIRSTEN E JACOBSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBSON
Provider First Name:
KIRSTEN
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396773131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 WEST BRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAUGERTIES
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-246-3000
Provider Business Mailing Address Fax Number:
845-246-7622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 ROUTE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAPPINGERS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12590-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-297-2511
Provider Business Practice Location Address Fax Number:
845-297-4993
Provider Enumeration Date:
06/29/2006

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: 207P00000X , with the licence number:  206698 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 206698 1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080164854 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6012114 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080324000053 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123349 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0191949 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01995239 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9X9381 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com