Provider Demographics
NPI:1851655765
Name:JACOB, LEENA RACHEL (DO)
Entity Type:Individual
Prefix:
First Name:LEENA
Middle Name:RACHEL
Last Name:JACOB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LEENA
Other - Middle Name:RACHEL
Other - Last Name:PHILIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1705
Mailing Address - Country:US
Mailing Address - Phone:856-547-6000
Mailing Address - Fax:856-546-3189
Practice Address - Street 1:318 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1705
Practice Address - Country:US
Practice Address - Phone:856-547-6000
Practice Address - Fax:856-546-3189
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017348207Q00000X
NJ25MB09680500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine