Provider Demographics
NPI:1992259790
Name:MCCARTNEY, JACOB (ATC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:MCCARTNEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LAUREL CT
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3242
Mailing Address - Country:US
Mailing Address - Phone:732-766-1551
Mailing Address - Fax:
Practice Address - Street 1:1225 RAIDER WAY
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4576
Practice Address - Country:US
Practice Address - Phone:848-992-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00210600172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker