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NPI Code Detail

MEDICARE: BETSY JACOB

MEDICARE: BETSY JACOB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist46TR00348700NJ

General Provider Information

NPI Number : 1184742942
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETSY JACOB
Provider Business Mailing Address
First Line : 167 CHRISTIE ST
Second Line :
City : LEONIA
State : NJ
Zip : 07605-1901
Country : US
Telephone Number : 201-983-3026
Fax Number :
Provider Business Practice Location Address
First Line : 330 FRANKLIN TPKE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-1932
Country : US
Telephone Number : 201-447-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 07/08/2007

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Directions to “ BETSY JACOB ” Practice Location

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