George, Jerry Jacob
George, Jerry Jacob is an sole proprietor health care provider with primary practice located at 49 Nesconset Hwy , Port Jefferson Station NY 11776-2628. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hematology & Oncology, which is considered as his primary health care specialty. George, Jerry Jacob can be contacted via phone (631) 751-3000.Contact Information
Primary practice address
49 Nesconset Hwy
Port Jefferson Station NY 11776-2628
Phone: (631) 751-3000
Fax: (631) 509-6559
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hematology & Oncology | 207RH0003X | 249204 | New York |
Profile Details
| NPI number | 1972765733 |
|---|---|
| LBN Legal business name | George, Jerry Jacob |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 1st, 2008 |
| Last updated | Jan 17th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972765733 | NPPES |
| New York | MEDICAID | 03105479 | |
| New York | Other | 9127406 | |
| New York | Other | 2999511 | |
| New York | Other | 38Q771 |
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