Provider Demographics
NPI:1881639011
Name:JACKMAN, EARL F (DO)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:F
Last Name:JACKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3348
Mailing Address - Country:US
Mailing Address - Phone:732-914-1919
Mailing Address - Fax:732-341-3303
Practice Address - Street 1:222 OAK AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3348
Practice Address - Country:US
Practice Address - Phone:732-914-1919
Practice Address - Fax:732-341-3303
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04461200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5944918004OtherCIGNA HMO
NJ010045046NJ01OtherST BARNABAS HEALTH
NJ0159635000OtherAMERIHEALTH NJ
NJ0176109Medicaid
NJF02902OtherHEALTH NET PHS
NJ429240OtherAMERIHEALTH ADMIN
NJVP016OtherOXFORD
NJ5944918OtherCIGNA COMED
NJVP016OtherOXFORD
NJ429240B80Medicare ID - Type Unspecified