Active NPI
Ellis Jacobs, PHD
- Diplomate Laboratory Management Specialist/Technologist
- Teaneck, NJ
National Provider Identifier
1720256910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diplomate Laboratory Management Specialist/Technologist
- License
- JACOE1
- Practice address
- 540 Wyndham Rd
Teaneck, NJ 07666-2612 - Phone
- (201) 836-1518
- Fax
- (212) 318-4699
- NPI assigned
- Feb 11, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diplomate Laboratory Management Specialist/Technologist | 246QL0901X | JACOE1 | NY | Primary |
Addresses
Primary practice location
540 Wyndham Rd
Teaneck, NJ 07666-2612
Mailing address
540 Wyndham Rd
Teaneck, NJ 07666-2612
Phone (201) 836-1518
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JACOE1 | NY | MD | Diplomate Laboratory Management Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372636800000",
"number": "1720256910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 WYNDHAM RD",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076662612",
"telephone_number": "201-836-1518",
"fax_number": "212-318-4699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 WYNDHAM RD",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076662612",
"telephone_number": "201-836-1518",
"fax_number": "212-318-4699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "ELLIS",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-11",
"last_updated": "2013-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "246QL0901X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Pathology, Laboratory Management, Diplomate",
"state": "NY",
"license": "JACOE1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Teaneck, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.