| Doctor Name: | MICHAEL YAKUBOV JACOBI |
| NPI Number: | 1861818650 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 274080 |
| Business Practice Address: | 8335 139th St Apt 1r Jamaica, NY - 114351600 |
| Business Phone Number: | 9172548854 |
| Business Fax Number: | 5093518279 |
| Mailing Address: | 8335 139th St, Apt 1r JAMAICA |
| State: | NY |
| Postal Code: | 114351600 |
| Phone Number: | 9172548854 |
| Fax Number: | 5093518279 |
| NPI Enumeration Date: | 03/17/2014 |
| NPI Last Update Date: | 03/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 274080 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |