Individual
MRS. SOPHIAMMA A JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
26 THROCKMORTON LN, OLD BRIDGE, NJ 08857-2520
(732) 679-9950
(732) 679-9956
Mailing address
20 GOSHAWK CT, MORGANVILLE, NJ 07751-1073
(732) 591-2255
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
26NJ00527100
NJ
Other
Enumeration date
01/21/2015
Last updated
01/21/2015
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