Healthcare Provider Details

I. General information

NPI: 1871956292
Provider Name (Legal Business Name): MS. JAROSLAVA ANNA JACUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 04/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CORPORATE PL S SUITE 205
PISCATAWAY NJ
08854-6148
US

IV. Provider business mailing address

10 CORPORATE PL S SUITE 205
PISCATAWAY NJ
08854-6148
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: