Jeena Jacob, M.D.
Individual provider Active NPI Emergency Medicine Physician · Newark, NJ
NPI 1285898684 · NPPES record last updated Mar 28, 2018
Key facts
- NPI
- 1285898684
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 49154 (CO)
- Practice address
- 150 Bergen Street
Emergency Department
Newark, NJ 07103-2496 - Phone
- (973) 972-5128
- Fax
- (973) 972-6646
- NPI assigned
- Jul 15, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49154 | CO | MD | Emergency Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 49154 | CO | Yes |
Addresses
Primary practice location
150 Bergen Street
Emergency Department
Newark, NJ 07103-2496
Mailing address
150 Bergen Street
Emergency Department
Newark, NJ 07103-2496
Phone (973) 972-5128
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64302083 | Medicaid | CO | |
| 022167 | Other | CO | KAISER COMMERCIAL NUMBER |
Other providers in Newark, NJ
- Shadane Jackson
- Talicia Jackson
- Terri Jackson
- Christine Ann Jacob
- Denise Jacob
- Jerril Jacob
- Jisha Rachel Jacob
- Tyler Branson Jacobs
- Jennifer Jacobson
- Jacqueline Spencer Memorial Counseling Center
All providers in Newark, NJ · Emergency Medicine Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.