Healthcare Provider Details

I. General information

NPI: 1336306638
Provider Name (Legal Business Name): JACOBY & MORRIS DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 FIRST ST
HO HO KUS NJ
07423-1575
US

IV. Provider business mailing address

119 FIRST ST
HO HO KUS NJ
07423-1575
US

V. Phone/Fax

Practice location:
  • Phone: 201-652-7711
  • Fax: 201-652-7350
Mailing address:
  • Phone: 201-652-7711
  • Fax: 201-652-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. WILLIAM E. JACOBY
Title or Position: PRESIDENT
Credential: DDS
Phone: 201-652-7711