Provider Demographics
NPI:1356347066
Name:STROH, JACK A (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:A
Last Name:STROH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:75 VERONICA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5002
Mailing Address - Country:US
Mailing Address - Phone:732-247-7444
Mailing Address - Fax:732-247-5119
Practice Address - Street 1:75 VERONICA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5002
Practice Address - Country:US
Practice Address - Phone:732-247-7444
Practice Address - Fax:732-247-5119
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2017-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA49346207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0547701Medicaid
NJ0547701Medicaid
NJE53227Medicare UPIN