Provider Demographics
NPI:1356311609
Name:JACOBY, DANA B (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:B
Last Name:JACOBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:21 NORTH GILBERT STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4950
Mailing Address - Country:US
Mailing Address - Phone:732-530-4545
Mailing Address - Fax:732-530-5741
Practice Address - Street 1:766 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3001
Practice Address - Country:US
Practice Address - Phone:732-530-4545
Practice Address - Fax:732-530-5741
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06592200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ959061Medicare PIN