Provider Demographics
NPI:1639213853
Name:JACOBY, THOMAS GERHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GERHARD
Last Name:JACOBY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LEXINGTON AVENUE
Mailing Address - Street 2:#120
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:212-665-3452
Mailing Address - Fax:
Practice Address - Street 1:133B SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850
Practice Address - Country:US
Practice Address - Phone:732-545-9009
Practice Address - Fax:732-545-9193
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04408811223G0001X
NJD18148122300000X
NY044088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice