Individual
SAMUEL SUNNY JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1200 EAST RIDGEWOOD AVENUE, EAST WING, SUITE 306,, RIDGEWOOD, NJ 07450
(201) 612-4857
Mailing address
18 MARTINO WAY, POMONA, NY 10970-2649
(914) 318-0088
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
25MB11490200
NJ
Other
Enumeration date
03/28/2017
Last updated
08/18/2022
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