Individual
JACOB D BLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4755 OLGETOWN STATON RD, NEWARK, DE 19718-0001
(302) 733-1043
Mailing address
4755 OLGETOWN STATON RD, NEWARK, DE 19718-0001
(302) 733-1043
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2025044588
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/13/2021
Last updated
11/17/2025
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