Individual
MARIA JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
924 LAKE SHORE DR, PARSIPPANY, NJ 07054-3986
(973) 932-7401
Mailing address
924 LAKE SHORE DR, PARSIPPANY, NJ 07054-3986
(973) 932-7401
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007899
IL
363AM0700X
Medical Physician Assistant
25MP00536800
NJ
Other
Enumeration date
11/06/2017
Last updated
02/08/2021
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