Provider Demographics
NPI:1487312930
Name:COCAB, JAD
Entity type:Individual
Prefix:
First Name:JAD
Middle Name:
Last Name:COCAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 ELLA LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-3012
Mailing Address - Country:US
Mailing Address - Phone:732-586-9333
Mailing Address - Fax:
Practice Address - Street 1:476 W UNION AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1221
Practice Address - Country:US
Practice Address - Phone:732-805-4014
Practice Address - Fax:732-805-4018
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04223900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist