1538156963 NPI number — DR. STUART JACOB DPM

Table of content: DR. STUART JACOB DPM (NPI 1538156963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538156963 NPI number — DR. STUART JACOB DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOB
Provider First Name:
STUART
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538156963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 W BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08016-1343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-386-0217
Provider Business Mailing Address Fax Number:
609-386-2205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 W BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08016-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-386-0217
Provider Business Practice Location Address Fax Number:
609-386-2205
Provider Enumeration Date:
09/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  25MD00189200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 223483019 . This is a "PALMETTO RAILROAD MEDICAR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0099360000 . This is a "INDEPENDENCE BLUE CROSS PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6324401 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: J013907 . This is a "TRICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0099360000 . This is a "INDEPENDENCE BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223483019 . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223483019 . This is a "INDEPENDENCE BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4146690001 . This is a "DME REGION A" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: BNS146 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 000781126001 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6111499 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0099360000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0183361 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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