Provider Demographics
NPI:1689317984
Name:ENYIA, JACOB OTU (MD)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:OTU
Last Name:ENYIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:355 GRAND STREET
Mailing Address - Street 2:DEPARTMENT OF MEDICINE 1 EAST
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-915-2431
Mailing Address - Fax:201-915-2219
Practice Address - Street 1:355 GRAND STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE 1 EAST
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-915-2431
Practice Address - Fax:201-915-2219
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program