| Doctor Name: | MR. RAYMOND PATRICK JACOB |
| NPI Number: | 1255515409 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | C.O.T.A. |
| License Number: | 002794 |
| Business Practice Address: | 24 Ferguson Ave Port Jervis, NY - 127711605 |
| Business Phone Number: | 9144437973 |
| Business Fax Number: | |
| Mailing Address: | 24 Ferguson Ave., PORT JERVIS |
| State: | NY |
| Postal Code: | 127711605 |
| Phone Number: | 9144437973 |
| Fax Number: | |
| NPI Enumeration Date: | 12/24/2007 |
| NPI Last Update Date: | 12/24/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246ZA2600X |
| License Number: | 002794 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | Art, Medical |
| Taxonomy Definition: | |