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Contact Information

JACOB H ETTINGER, PA
21 CANTERBURY RD
APARTMENT #3
GREAT NECK, NY11021-2123
 Phone: 516-570-6015
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical

363AS0400X 97 Physician Assistant
 

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for JACOB H ETTINGER · (Male)

NPI # 1063441517
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 06/30/2006
Last updated 09/11/2025 - About 9 months ago
Sole proprietor 1 No
Identifiers
  • NY License # 009528
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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