Provider Demographics
NPI:1811764236
Name:JACOBUS, THOMAS C (LAT, ATC, EMT-B)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:JACOBUS
Suffix:
Gender:M
Credentials:LAT, ATC, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 3RD AVE # 1
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1520
Mailing Address - Country:US
Mailing Address - Phone:973-818-9325
Mailing Address - Fax:
Practice Address - Street 1:26 3RD AVE # 1
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1520
Practice Address - Country:US
Practice Address - Phone:973-818-9325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001551002255A2300X
NJ558323146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer