Provider Demographics
NPI:1376625145
Name:JACOBSON, LOUIS ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:ROBERT
Last Name:JACOBSON
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 1:106 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1912
Mailing Address - Country:US
Mailing Address - Phone:973-729-7400
Mailing Address - Fax:973-729-2201
Practice Address - Street 1:106 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1912
Practice Address - Country:US
Practice Address - Phone:973-729-7400
Practice Address - Fax:973-729-2201
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07459800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics