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Jerry Jacob

  • Male

Medical Specialty

Professional ID

  • NPI: 1538571799
  • PECOS ID: 9234452038
  • Enrollment ID: I20141231001850
  • Credential(MD, DO, DPM):
  • Medical School: Columbia University College Of Physicians And Surgeons
  • Medical School Graduation Year: 2014

Hospital Service

  • Hospital CCN1: 330107
  • Business Name (LBN)1: Peconic Bay Medical Center
  • Hospital CCN2: 330246
  • Business Name (LBN)2: St Charles Hospital
  • Hospital CCN3: 330185
  • Business Name (LBN)3: John T Mather Memorial Hospital Of Port Jefferson

Medical Practices

  • Organization Name: Long Island Anesthesia Physicians Llp
  • Group Practice ID assigned by PECOS: 7113825381
  • Number of Group Practice member: 70

Location

  • Address1: 75 N Country Rd
  • Address2:
  • City: Port Jefferson
  • State: New York
  • Zip Code: 11777
  • Phone Number: (631)736-4064

Medicare

  • Medicare Assignment: Yes
  • Report Quality of Care to Physician Quality Reporting System (PQRS):
  • Used Electronic health record (EHR):