Healthcare Provider Details

I. General information

NPI: 1063552016
Provider Name (Legal Business Name): JACQUES G LOSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLIAMSON STREET SUITE 104
ELIZABETH NJ
07207
US

IV. Provider business mailing address

151 BRENTWOOD DR
SOUTH ORANGE NJ
07079-1132
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5480
  • Fax:
Mailing address:
  • Phone: 973-274-1240
  • Fax: 908-994-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA04496200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: