Individual provider · Type 1 NPI
Jacob Henry Ettinger, PA
Surgical Physician Assistant · Great Neck, NY
NPI number
1063441517
Active
Practice location
21 Canterbury Rd, Apartment #3
Great Neck, NY 11021-2123
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | 009528 (NY) |
| Surgical Physician Assistant Primary | 363AS0400X | 009528 (NY) |
Surgical Physician Assistant: Definition to come...
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About NPI 1063441517
Jacob Henry Ettinger, PA's National Provider Identifier is 1063441517, issued on Jun 30, 2006. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Great Neck, NY. The record was last updated on Sep 11, 2025.