Provider Demographics
NPI:1043360225
Name:LORBER, JACOB JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JAY
Last Name:LORBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10453 YOLANDA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3439
Mailing Address - Country:US
Mailing Address - Phone:818-368-9087
Mailing Address - Fax:818-368-9087
Practice Address - Street 1:10453 YOLANDA AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-3439
Practice Address - Country:US
Practice Address - Phone:818-368-9087
Practice Address - Fax:818-368-9087
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG13948208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F38797Medicare UPIN