Provider Demographics
NPI:1073770798
Name:JACOBUS, DAVID PENMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PENMAN
Last Name:JACOBUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CLEVELAND LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3049
Mailing Address - Country:US
Mailing Address - Phone:609-921-6421
Mailing Address - Fax:609-799-1176
Practice Address - Street 1:37 CLEVELAND LN
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3049
Practice Address - Country:US
Practice Address - Phone:609-921-6421
Practice Address - Fax:609-799-1176
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03110400208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice