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General NPI Number Information
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NPI Number | 1215861737
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Entity Type | Individual
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Provider Name | MINA JACOB
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Gender | Male
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 347 MAIN ST # 3
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City | CHESTER
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State | NJ
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Zip | 07930-2691
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Country | US
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Telephone | 862-500-4735
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Fax |
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Provider Business Mailing Address
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Address Line | 929 OLD BRIDGE TPKE
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3849
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Country | US
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Telephone | 201-469-1765
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02423900
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License Number State | NJ
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