Individual
TAMAR JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16 FAIRVIEW AVE, BERGENFIELD, NJ 07621-2806
(929) 777-4675
Mailing address
16 FAIRVIEW AVE, BERGENFIELD, NJ 07621-2806
(929) 777-4675
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
C80871354178562
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C80871354178562
CLC
—
Enumeration date
08/10/2022
Last updated
08/10/2022
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