Active NPI
Paul Jacobs, PH.D.
- Clinical Psychologist
- Fort Lee, NJ
National Provider Identifier
1619136173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 018887
- Practice address
- 1 Horizon Rd
Apt. 1423
Fort Lee, NJ 07024-6502 - Phone
- (954) 563-9954
- NPI assigned
- Jun 9, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY5128 | FL | |
| Clinical Psychologist | 103TC0700X | 35SI00481500 | NJ | |
| Clinical Psychologist | 103TC0700X | 018887 | NY | Primary |
Addresses
Primary practice location
1 Horizon Rd
Apt. 1423
Fort Lee, NJ 07024-6502
Mailing address
1 Horizon Rd
Apt. 1423
Fort Lee, NJ 07024-6502
Phone (954) 563-9954
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY5128 | FL | MD | Clinical Psychologist |
| 018887 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338422400000",
"number": "1619136173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 HORIZON RD",
"address_2": "APT. 1423",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "070246502",
"telephone_number": "954-563-9954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 HORIZON RD",
"address_2": "APT. 1423",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "070246502",
"telephone_number": "954-563-9954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "PAUL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-09",
"last_updated": "2012-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY5128",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "35SI00481500",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "018887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lee, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.