Healthcare Provider Details

I. General information

NPI: 1053275750
Provider Name (Legal Business Name): MORT JACOBS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 PARK AVE
PATERSON NJ
07504-1532
US

IV. Provider business mailing address

506 PARK AVE
PATERSON NJ
07504-1532
US

V. Phone/Fax

Practice location:
  • Phone: 973-279-4600
  • Fax: 973-278-2666
Mailing address:
  • Phone: 973-279-4600
  • Fax: 973-278-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: BHAVINI SHAH
Title or Position: PRESIDENT
Credential:
Phone: 973-279-4600