Provider Demographics
NPI:1174746846
Name:DANA B. JACOBY, MD, LLC
Entity type:Organization
Organization Name:DANA B. JACOBY, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-530-4545
Mailing Address - Street 1:766 SHREWSBURY AVENUE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724
Mailing Address - Country:US
Mailing Address - Phone:732-530-4545
Mailing Address - Fax:732-530-5741
Practice Address - Street 1:766 SHREWSBURY AVENUE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724
Practice Address - Country:US
Practice Address - Phone:732-530-4545
Practice Address - Fax:732-530-5741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ959061207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ959061Medicare PIN