Provider Demographics
NPI:1124170899
Name:JACQUES, ARNOLD J (MD)
Entity type:Individual
Prefix:MR
First Name:ARNOLD
Middle Name:J
Last Name:JACQUES
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:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:732-634-0700
Mailing Address - Fax:732-634-2020
Practice Address - Street 1:655 AMBOY AVENUE
Practice Address - Street 2:SUITE 306
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095
Practice Address - Country:US
Practice Address - Phone:732-634-0700
Practice Address - Fax:732-634-2020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA047118002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0750301Medicaid
NJC54787Medicare UPIN
NJ0750301Medicaid
446138Medicare PIN