Individual provider · Type 1 NPI

Stacy Jacob

Physician Assistant · Staten Island, NY

NPI number 1104333178 Active

Practice location

475 Seaview Ave
Staten Island, NY 10305-3436

Call (718) 266-9000 Map

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse 164W00000X329541-1 (NY)
Physician Assistant Primary 363A00000X25MP00995000 (NJ)
Physician Assistant 363A00000XNone listed

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1104333178

Stacy Jacob's National Provider Identifier is 1104333178, issued on Dec 29, 2017. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Staten Island, NY. The record was last updated on Feb 2, 2026.