Organization
STUART JACOB DPM PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STUART JACOB DPM (PRESIDENT)
(609) 386-0217
Entity
Organization
Contact information
Practice address
319 W BROAD ST, BURLINGTON, NJ 08016-1343
(609) 386-0217
(609) 386-2205
Mailing address
319 W BROAD ST, BURLINGTON, NJ 08016-1343
(609) 386-0217
(609) 386-2205
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
MD01892
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2093185000
INDEPENDENCE BLUE SHIELD
—
01
—
480033923
PALMETTO MEDICARE
—
05
—
5486906
—
NJ
05
—
6324401
—
NJ
05
—
7159901
—
NJ
Enumeration date
06/26/2006
Last updated
11/23/2009
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