Individual
FITZROY JACOBS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
151 CENTENNIAL AVE, PISCATAWAY, NJ 08854-3907
(732) 235-6184
Mailing address
671 HOES LN W, PISCATAWAY, NJ 08854-8021
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4144007
—
NJ
Enumeration date
12/17/2013
Last updated
12/17/2013
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