Provider Demographics
NPI:1003304494
Name:JAKUB, GABRIELLE VINCENZA
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:VINCENZA
Last Name:JAKUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MORRIS AVE APT 40
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1554
Mailing Address - Country:US
Mailing Address - Phone:908-721-1054
Mailing Address - Fax:
Practice Address - Street 1:417 MORRIS AVE APT 40
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-1554
Practice Address - Country:US
Practice Address - Phone:908-721-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist