Individual
JEENA MARY JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
801 OSTRUM ST, BETHLEHEM, PA 18015-1000
(610) 954-6643
Mailing address
7080 HEARTH LN, MACUNGIE, PA 18062-9249
(717) 521-4116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD434858
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102198184
—
PA
Enumeration date
09/06/2007
Last updated
03/04/2011
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