Individual ProviderStacy JacobPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address475 Seaview Ave, Staten Island, NY 10305-3436(718) 266-9000(718) 226-9000PECOS EnrollmentBased on the most recent information from CMS, provider Stacy Jacob is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1104333178Provider TypeIndividualFull NameJacob, StacyTitleMissGenderFemaleSole ProprietorNoEnumeration Date12/29/2017Last Updated1/21/2023Contact InformationPractice LocationPractice Address475 Seaview Ave, Staten Island, NY 10305-3436Phone(718) 266-9000FaxUnlisted FaxMailing LocationMailing Address475 Seaview Ave, Staten Island, NY 10305-3436Phone(718) 226-9000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerCode164W00000XDescriptionLicensed Practical NurseNursing Service ProvidersLicense329541-1New York