Provider Demographics
NPI:1780420307
Name:JACOB, ARIEL ISAIAH (DO)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:ISAIAH
Last Name:JACOB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 RUTHERFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1238
Mailing Address - Country:US
Mailing Address - Phone:516-282-4737
Mailing Address - Fax:
Practice Address - Street 1:415 RUTHERFORD BLVD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1238
Practice Address - Country:US
Practice Address - Phone:516-282-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty