Provider Demographics
NPI:1841289857
Name:JACOBY, MICHELLE P (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:P
Last Name:JACOBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:180 WHITE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1166
Mailing Address - Country:US
Mailing Address - Phone:732-842-0673
Mailing Address - Fax:732-842-7352
Practice Address - Street 1:180 WHITE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1166
Practice Address - Country:US
Practice Address - Phone:732-842-0673
Practice Address - Fax:732-842-7352
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2013-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06597700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG58630Medicare UPIN