Individual
JULIANNE SUSAN JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,PA-C
Contact information
Practice address
225 WILLIAMSON ST, ELIZABETH, NJ 07202-3625
(973) 563-8430
Mailing address
371 N 10TH ST, PROSPECT PARK, NJ 07508-2214
(973) 563-8430
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9578
GA
363AM0700X
Medical Physician Assistant
25MP00473800
NJ
Other
Enumeration date
06/19/2018
Last updated
07/05/2022
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