Provider Demographics
NPI:1114167350
Name:JACOB, JOBEY (MD)
Entity Type:Individual
Prefix:
First Name:JOBEY
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 KYLES WAY
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6621
Mailing Address - Country:US
Mailing Address - Phone:516-476-5452
Mailing Address - Fax:
Practice Address - Street 1:365 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4217
Practice Address - Country:US
Practice Address - Phone:203-932-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-28
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049082208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics