Individual
TONY JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
205 HOMESTEAD RD, PARAMUS, NJ 07652-4709
(516) 587-3406
Mailing address
205 HOMESTEAD RD, PARAMUS, NJ 07652-4709
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
015918
NY
363A00000X
Physician Assistant
Primary
25MP00294500
NJ
Other
Enumeration date
10/01/2012
Last updated
06/03/2016
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