Healthcare Provider Details

I. General information

NPI: 1790873891
Provider Name (Legal Business Name): JACOB E. MARKOVITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PL SUITE 305
ENGLEWOOD NJ
07631-4957
US

IV. Provider business mailing address

25 ROCKWOOD PL SUITE 305
ENGLEWOOD NJ
07631-4957
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-0003
  • Fax: 201-894-0006
Mailing address:
  • Phone: 201-894-0003
  • Fax: 201-894-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number25MA08052400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA08052400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: