Individual
JISHA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
615 MAIN AVE # 7055, PASSAIC, NJ 07055-5066
(800) 200-8196
Mailing address
47 OLD MIDDLETOWN RD, NANUET, NY 10954-3208
(708) 296-9823
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
209030880
IL
207Q00000X
Family Medicine Physician
357923
NY
363LF0000X
Family Nurse Practitioner
Primary
26NJ15521400
NJ
Other
Enumeration date
03/04/2025
Last updated
07/09/2026
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