Provider Demographics
NPI:1316902968
Name:JACOBS, GERALD (DO)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 CEDARBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-477-5600
Mailing Address - Fax:732-477-1899
Practice Address - Street 1:985 CEDARBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:732-477-5600
Practice Address - Fax:732-477-1899
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02080200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D19814Medicare UPIN
1502506Medicare ID - Type Unspecified