Individual
MICKY JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP
Contact information
Practice address
65 JAMES ST, EDISON, NJ 08820-3903
(732) 321-7000
Mailing address
65 JAMES ST, EDISON, NJ 08820-3903
(732) 321-7000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26NJ14848700
NJ
Other
Enumeration date
05/24/2023
Last updated
05/24/2023
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