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Jacob Lane Dickinson, DO
Student in an Organized Health Care Education/Training Program in Southampton, New York
NPI 1407316821

Jacob Lane Dickinson is a Student in an Organized Health Care Education/Training Program based in Southampton, NY. Jacob Lane Dickinson practices in Southampton, NY and has the professional credentials of DO. The NPI Number for Jacob Lane Dickinson is 1407316821 and holds a License No. (New York).

The current practice location address for Jacob Lane Dickinson is 240 Meeting House Ln, Southampton, NY and can be reached out via phone at 631-726-0409.

Location: 240 Meeting House Ln, Southampton, NY, 11968-5009
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1407316821
Provider Name
Jacob Lane Dickinson
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
240 Meeting House Ln, Southampton, NY, 11968-5009
Phone Number
631-726-0409
Fax Number
Provider Enumeration Date
03/21/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
240 Meeting House Ln
City
Southampton
State
New York
Zip
11968-5009
Phone Number
631-726-0409
Fax Number
person
Provider Business Mailing Address Details
Address
240 Meeting House Ln
City
Southampton
State
New York
Zip
11968-5009
Phone Number
631-726-0409
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
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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