MEDICARE: DAVID JAY JACOBS MD

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
1	208100000X	Physical Medicine & Rehabilitation Physician	25MA04130000	NJ

General Provider Information

NPI Number	:	1205846342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JAY JACOBS MD

Provider Business Mailing Address
First Line	:	554 WHITE OAK RIDGE ROAD
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078
Country	:	US
Telephone Number	:	973-379-6824
Fax Number	:	973-379-7742

Provider Business Practice Location Address
First Line	:	554 WHITE OAK RIDGE RD
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-1338
Country	:	US
Telephone Number	:	973-379-6824
Fax Number	:	973-379-7742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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