Provider Demographics
NPI:1952037053
Name:DEARBORN, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:DEARBORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18910-0145
Mailing Address - Country:US
Mailing Address - Phone:267-374-2313
Mailing Address - Fax:
Practice Address - Street 1:750 KELLERS CHURCH RD
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18910
Practice Address - Country:US
Practice Address - Phone:267-374-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program