Gregg Andrew Jacob, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

22DI02252800 Issued in NJ

Practice address

83 Hanover Rd Ste 240
Florham Park, NJ 07932-1508

Phone

(973) 360-1100

Fax

(973) 360-1101

NPI assigned

Mar 27, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New York Comprehensive Orthognathic and Maxillofacial Surgery PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • New Hyde Park, NY
  • NPI 1699782219

  NY, Oral & Maxillofacial Surgery

  Medicare reassignment NPD
• North American Partners in Anesthesia of New Jersey LLC

  • Anesthesiology Physician
  • Brick, NJ
  • NPI 1548433048
  NPD (past)
• Summit Oral and Maxillofacial Surgery,PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Summit, NJ
  • NPI 1437275716

  Oral and Maxillofacial Surgery

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1164540233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 HANOVER RD STE 240",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079321508",
            "telephone_number": "973-360-1100",
            "fax_number": "973-360-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 HANOVER RD STE 240",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079321508",
            "telephone_number": "973-360-1100",
            "fax_number": "973-360-1101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 Marcus Ave",
            "address_2": "Ste N-10",
            "address_purpose": "LOCATION",
            "city": "New Hyde Park",
            "state": "NY",
            "postal_code": "110421011",
            "country_code": "US",
            "telephone_number": "516-775-1818",
            "fax_number": "516-775-0892",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "GREGG",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI02252800",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NY",
            "license": "054217-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "91001810700",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ira Hauptman DPM PC
• Ethan Isidro, MD
• Maksim Ivanouski
• Hariharan Venkatachalam Iyer, M.D.
• J. G. Moreno, MD, LLC
• Julie Jacob, APN
• Karen Sarah Jacob, LCSW
• Jennifer May Jacobs, M.S. CCC-SLP
• Lili Rachel Jacobson, LPC
• Jade and Cinnabar Acupuncture and Oriental Medicine, Inc

• All providers in Florham Park, NJ
• Oral and Maxillofacial Surgery (Dentist) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.