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NPI Code Detail

MEDICARE: AMIRA JACOB AU.D.CCC A

MEDICARE: AMIRA JACOB AU.D.CCC A
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
1231H00000XAudiologist41YA00063000NJ

General Provider Information

NPI Number : 1841363116
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMIRA JACOB AU.D.CCC A
Provider Business Mailing Address
First Line : 44 MILLTOWN RD
Second Line :
City : EAST BRUNSWICK
State : NJ
Zip : 08816-2356
Country : US
Telephone Number : 732-238-1664
Fax Number :
Provider Business Practice Location Address
First Line : 44 MILLTOWN RD
Second Line :
City : EAST BRUNSWICK
State : NJ
Zip : 08816-2356
Country : US
Telephone Number : 732-238-1664
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 03/02/2010

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