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General NPI Number Information
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NPI Number | 1528612231
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Entity Type | Individual
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Provider Name | STEPHANIE T JACOBOVITS DMD
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Gender | Female
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Dates
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Enumeration Date | 07/31/2019
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 140 MARKET ST
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City | PATERSON
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State | NJ
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Zip | 07505-1471
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Country | US
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Telephone | 973-742-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 98 WESTERVELT PL
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City | PASSAIC
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State | NJ
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Zip | 07055-4627
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Country | US
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Telephone | 862-247-9706
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02770700
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License Number State | NJ
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