Provider Demographics
NPI:1811042575
Name:JACOBS, ABBIE (MD)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2502
Mailing Address - Country:US
Mailing Address - Phone:201-418-3125
Mailing Address - Fax:201-418-3148
Practice Address - Street 1:122 CLINTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2502
Practice Address - Country:US
Practice Address - Phone:201-418-3100
Practice Address - Fax:201-418-3148
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05803000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5616409Medicaid
NJE86318Medicare UPIN
NJ0374N2ZMedicare ID - Type Unspecified