Provider Demographics
NPI:1063552016
Name:LOSMAN, JACQUES G (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:G
Last Name:LOSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1132
Mailing Address - Country:US
Mailing Address - Phone:973-274-1240
Mailing Address - Fax:908-994-8802
Practice Address - Street 1:240 WILLIAMSON STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07207
Practice Address - Country:US
Practice Address - Phone:908-994-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04496200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3710301Medicaid
NJC56752Medicare UPIN
NJ520749Medicare ID - Type Unspecified