Individual
JEENA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
150 BERGEN STREET, EMERGENCY DEPARTMENT, NEWARK, NJ 07103-2496
(973) 972-5128
(973) 972-6646
Mailing address
150 BERGEN STREET, EMERGENCY DEPARTMENT, NEWARK, NJ 07103-2496
(973) 972-5128
(973) 972-6646
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
49154
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022167
KAISER COMMERCIAL NUMBER
CO
05
—
64302083
—
CO
Enumeration date
07/15/2008
Last updated
03/28/2018
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