Provider Demographics
NPI:1790873891
Name:MARKOVITZ, JACOB E (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:E
Last Name:MARKOVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25 ROCKWOOD PL
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4957
Mailing Address - Country:US
Mailing Address - Phone:201-894-0003
Mailing Address - Fax:201-894-0006
Practice Address - Street 1:25 ROCKWOOD PL
Practice Address - Street 2:SUITE 305
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4957
Practice Address - Country:US
Practice Address - Phone:201-894-0003
Practice Address - Fax:201-894-0006
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08052400173000000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ237196Medicare UPIN