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General NPI Number Information
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NPI Number | 1497195515
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Entity Type | Individual
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Provider Name | JACOB SCUTARU MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2013
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 1771 MADISON AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1242
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Country | US
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Telephone | 732-364-6666
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Fax |
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Provider Business Mailing Address
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Address Line | 31 HAMLIN RD
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City | EDISON
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State | NJ
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Zip | 08817-2950
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA11825900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 286492
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 25MA11825900
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License Number State | NJ
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