Tony Jacob, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00294500 Issued in NJ

Practice address

205 Homestead Rd
Paramus, NJ 07652-4709

Phone

(516) 587-3406

NPI assigned

Oct 1, 2012

Last updated

Jun 3, 2016By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

• Affinity Surgical Associates, LLC

  • Neurological Surgery Physician
  • Paramus, NJ
  • NPI 1962854232
  Medicare reassignment Authorized official
• First Assist Surgical Services

  • Orthopaedic Surgery of the Spine Physician
  • Paramus, NJ
  • NPI 1689003196
  Authorized official Same address or phone

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464912000000",
    "number": "1396096236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 HOMESTEAD RD",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076524709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 HOMESTEAD RD",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076524709",
            "telephone_number": "516-587-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "TONY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-01",
        "last_updated": "2016-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00294500",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015918",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louis B Izower, DDS, MS
• Jodi Jackson, LMT
• Bethsy Jacob, PHARMD
• Deepa Jacob, APN
• Merin Thomas Jacob, ANP-C
• Stephen Howard Jacobs, M.D.
• Adina Kwestel Jacobson, DPT
• Jae Yoon Shin DPM P.C.
• Zahra Batool Jafary, MD
• Summer Jaffrey, M.D.

• Physician Assistant in Paramus, NJ
• Providers in Paramus, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.