Provider Demographics
NPI:1104870765
Name:JACOB, SHOBHA (MS OTR CHT)
Entity type:Individual
Prefix:MRS
First Name:SHOBHA
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:MS OTR CHT
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 75
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-0075
Mailing Address - Country:US
Mailing Address - Phone:973-928-5800
Mailing Address - Fax:973-928-5801
Practice Address - Street 1:881 ALLWOOD RD STE 101
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1900
Practice Address - Country:US
Practice Address - Phone:973-928-5800
Practice Address - Fax:973-928-5801
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR001259225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087868Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER