Provider Demographics
NPI:1740370204
Name:JACOBS, STEPHEN HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HOWARD
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:230 E. RIDGEWOOD AVE
Mailing Address - Street 2:BERGEN REGIONAL MEDICAL CENTER
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4131
Mailing Address - Country:US
Mailing Address - Phone:201-967-4000
Mailing Address - Fax:201-967-7924
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:BERGEN REGIONAL MEDICAL CENTER
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4142
Practice Address - Country:US
Practice Address - Phone:201-967-4000
Practice Address - Fax:201-967-7924
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA22309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2078406Medicaid
NJ2078406Medicaid
NJ103840Medicare ID - Type Unspecified