Provider Demographics
NPI:1932306446
Name:PERSONAL IMAGE, P.C.
Entity Type:Organization
Organization Name:PERSONAL IMAGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DO, FACOS
Authorized Official - Phone:201-969-9900
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-0098
Mailing Address - Country:US
Mailing Address - Phone:201-969-9900
Mailing Address - Fax:
Practice Address - Street 1:680 KINDERKAMACK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1600
Practice Address - Country:US
Practice Address - Phone:201-969-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB069304002082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G82044Medicare UPIN
NJ044830Medicare ID - Type Unspecified