1245233469 NPI number — JOSEPH M JACOBS MD

Table of content: JOSEPH M JACOBS MD (NPI 1245233469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245233469 NPI number — JOSEPH M JACOBS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBS
Provider First Name:
JOSEPH
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1245233469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 OSTRUM ST
Provider Second Line Business Mailing Address:
SUITE 602
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18015-1152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-865-5888
Provider Business Mailing Address Fax Number:
610-865-1697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 OSTRUM ST
Provider Second Line Business Practice Location Address:
SUITE 602
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18015-1152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-865-5888
Provider Business Practice Location Address Fax Number:
610-865-1697
Provider Enumeration Date:
05/23/2005

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: 207RN0300X , with the licence number:  MD037424E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000155375601 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1521554 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40433 . This is a "GEISINGER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0011789700002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01201301 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000154067 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0067946 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20008418 . This is a "AMERIHEALTH MERCY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000129237 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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