LISA R JACOB MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036138036

License Status

NOT RENEWED

Business

Title

First Name

LISA

Middle

Last Name

JACOB

Business Name

LISA R JACOB MD

Original Issue Date

05/20/2015

Effective Date

05/20/2015

Expiration Date

07/31/2017

City

NEW YORK

State

Zip

10023

County

NEW YORK

Ever Disciplined

LastModifiedDate

11/01/2017