DR. SUSAN VIVIAN JACOB


Address: 14 Vanderventer Ave, Port Washington, NY 11050-3737
Phone: 5169443786

DR. SUSAN VIVIAN JACOB (NPI# 1467675819) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1467675819
Entity Type Individual
Full Name DR. SUSAN VIVIAN JACOB
Other Name SUSAN VIVIAN JAKOB
Credential PHD
Practice Address 14 Vanderventer Ave
Port Washington
NY 11050-3737
Practice Telephone 5169443786
Mailing Telephone 5169443786
Enumeration Date 2007-04-11
Last Update Date 2007-07-08
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TC2200X Psychologist
Specialization: Clinical Child & Adolescent
0077981 NY Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
NY LICENSE NUMBER 0077981 01

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1568685436 Susan Jacob Nurse Practitioner 710 W 168th Street, New York, NY 10032-2699 2007-04-10
1538207220 Susan Jacob Family Medicine 231 Albert Sabin Way, Cincinnati, OH 45267-2827 2007-02-02
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Office Location

Street Address 14 VANDERVENTER AVE
City PORT WASHINGTON
State NY
Zip Code 11050-3737

Providers in the same location

NPI Name Taxonomy Address Enumeration
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1790924942 Robin Perlberg Acupuncturist 14 Vanderventer Ave, Suite 145, Port Washington, NY 11050-3737 2009-02-11
1104096908 Rhonda Mae Yoss-kaplan Psychologist 14 Vanderventer Ave, Suite 103, Port Washington, NY 11050-3737 2008-03-07
1265629778 Daniela Spector Dentist 14 Vanderventer Ave, Suite 120, Port Washington, NY 11050-3737 2007-09-28
1508063264 Paul Dominic Verdi Dentist 14 Vanderventer Ave, Suite 140, Port Washington, NY 11050-3737 2007-06-27
1003942020 Joseph T Shen Internal Medicine 14 Vanderventer Ave, Suite 130-138, Port Washington, NY 11050-3737 2007-02-26
1063580967 Bill Stephen Wald Dentist 14 Vanderventer Ave, Ste 120, Port Washington, NY 11050 2006-12-01
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1144689696 One-care Physical Therapy Pllc Physical Therapist 45 B Dunwood Rd, Port Washington, NY 11050 2016-02-12
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1043515828 Tak Wai Chau Social Worker 36 Rockwood Ave, Port Washingto, NY 11050 2011-01-25
1073823167 Donna Lee Kosina Occupational Therapist 10 Maple Dr., Port Washington, NY 11050 2010-10-07
1962710467 Alicia Marie Leporati Counselor 9 Graywood Rd, Port Washington, NY 11050 2010-09-17
1164747630 Thomas Young Suh Pharmacist 100 Habor View Drive #630, Port Washington, NY 11050 2010-03-29
1376778142 Ellen J Satloff Social Worker 14 Terrace Drive, Port Washington, NY 11050 2009-05-22
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Taxonomy Information

Taxonomy Code 103TC2200X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Clinical Child & Adolescent

Taxonomy Definition

Definition to come...
Notes: [1/1/2007: title modified]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1639544968 Anita Sethi Psychologist 40 Pleasant Ave, Port Washington, NY 11050-2202 2015-12-11
1104096908 Rhonda Mae Yoss-kaplan Psychologist 14 Vanderventer Ave, Suite 103, Port Washington, NY 11050-3737 2008-03-07

Providers in the same taxonomy and state

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1922630631 Juliet Lisa Collingwood Psychologist 471 13th St, Brooklyn, NY 11215-5206 2020-02-11
1578102513 Anne Austin Weissenberger Psychologist 144 King St, Chappaqua, NY 10514-3499 2019-12-21
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1417502543 Norma Linda Doft Psychologist 295 Central Park W Ofc 4a, New York, NY 10024-3021 2019-08-06
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1043870728 Sarah Donovan Psychologist 5151 Fieldstone Trl, Canandaigua, NY 14424-8245 2019-06-16
1265099022 Michelle Gallagher Psychologist Upstate Medical University, 750 E. Adams St., Syracuse, NY 13210 2019-05-28
1063983757 Miriam Shields Psychologist 13681 71st Rd, Flushing, NY 11367-1942 2018-12-06
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Competitor

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City PORT WASHINGTON
Zip Code 11050

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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