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General NPI Number Information
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NPI Number | 1669706941
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Entity Type | Organization
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Legal Business Name | SPARTA PEDIATRICS, LLC
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Dates
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Enumeration Date | 09/20/2009
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Last Update Date | 09/20/2009
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Provider Practice Location Address
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Address Line | 106 MAIN ST
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City | SPARTA
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State | NJ
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Zip | 07871-1912
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Country | US
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Telephone | 973-729-7400
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Fax | 973-729-2201
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Provider Business Mailing Address
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Address Line | 106 MAIN ST
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City | SPARTA
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State | NJ
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Zip | 07871-1912
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Country | US
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Telephone | 973-729-7400
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Fax | 973-729-2201
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. LOUIS JACOBSON
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Credential | M.D.
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Telephone | 973-729-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 25MA07459800
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License Number State | NJ
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