Basic Information
| Provider Information | |||||||||
| NPI: | 1861998502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAKUBOWSKI | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 888 OLD COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | PLAINVIEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118034914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317271600 | ||||||||
| FaxNumber: | 6317278320 | ||||||||
| Practice Location | |||||||||
| Address1: | 34 COMMERCE AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119013118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317271600 | ||||||||
| FaxNumber: | 6317278320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2018 | ||||||||
| LastUpdateDate: | 04/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.