Healthcare Provider Details

I. General information

NPI: 1285544098
Provider Name (Legal Business Name): NJ PELVIC MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 TAYLORS MILLS RD STE 106
MANALAPAN NJ
07726-3281
US

IV. Provider business mailing address

10 WOODS RD
WEST LONG BRANCH NJ
07764-1127
US

V. Phone/Fax

Practice location:
  • Phone: 732-210-6555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: NINA JACOBSON
Title or Position: OWNER
Credential: MD
Phone: 917-855-4865