Provider Demographics
NPI:1669622015
Name:JACOB, EMAD (MD)
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:
Last Name:JACOB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EMAD
Other - Middle Name:
Other - Last Name:YAAKOUB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:715 KEARNEY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032
Mailing Address - Country:US
Mailing Address - Phone:201-772-5211
Mailing Address - Fax:201-428-1627
Practice Address - Street 1:715 KEARNEY AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NJ
Practice Address - Zip Code:07032
Practice Address - Country:US
Practice Address - Phone:201-772-5211
Practice Address - Fax:201-428-1627
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08462300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0179141Medicaid
NJ139757Medicare PIN