Individual provider · Type 1 NPI

Benna Thayil Jacob, DO

Student in an Organized Health Care Education/Training Program · Mineola, NY

NPI number 1477247948 Active

Practice location

222 Station Plz N Ste 509
Mineola, NY 11501-3893

Call (516) 663-2381 Map

Mailing address

130 Radcliffe Rd
Plainview, NY 11803-1218

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1477247948

Benna Thayil Jacob, DO's National Provider Identifier is 1477247948, issued on Jun 6, 2023. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Mineola, NY. The record was last updated on Jun 6, 2023.