1710911730 NPI number — ANTOINETTE H JAKOBI MD

Table of content: ANTOINETTE H JAKOBI MD (NPI 1710911730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710911730 NPI number — ANTOINETTE H JAKOBI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAKOBI
Provider First Name:
ANTOINETTE
Provider Middle Name:
H
Provider Name Prefix Text:
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:
HERSHMAN
Provider Other First Name:
ANTOINETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710911730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 ELMWOOD AVE
Provider Second Line Business Mailing Address:
BOX: PSYCH
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14642-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-586-5600
Provider Business Mailing Address Fax Number:
585-276-0161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 OFFICE PARK WAY
Provider Second Line Business Practice Location Address:
TOBEY VILLAGE OFFICE PARK
Provider Business Practice Location Address City Name:
PITTSFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14534-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-586-5600
Provider Business Practice Location Address Fax Number:
585-586-5512
Provider Enumeration Date:
07/10/2006

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: 2084P0800X , with the licence number:  193541 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: 1935411 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 101487EW . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010193541 . This is a "EXCELLUS BLUE CROSS BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01659154 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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