Provider Demographics
NPI:1205846342
Name:JACOBS, DAVID JAY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAY
Last Name:JACOBS
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 1:554 WHITE OAK RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078
Mailing Address - Country:US
Mailing Address - Phone:973-379-6824
Mailing Address - Fax:973-379-7742
Practice Address - Street 1:554 WHITE OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-1338
Practice Address - Country:US
Practice Address - Phone:973-379-6824
Practice Address - Fax:973-379-7742
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04130000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJA53767Medicare ID - Type Unspecified
C53701Medicare UPIN