NPIMap

Organization Active NPI

Stuart Jacob DPM PA

  • Foot & Ankle Surgery Podiatrist
  • Burlington, NJ
National Provider Identifier
1942236278
Registry record updated Nov 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
MD01892 Issued in NJ
Legal business name
STUART JACOB DPM PA
Practice address
319 W Broad St
Burlington, NJ 08016-1343
Phone
(609) 386-0217
Fax
(609) 386-2205
NPI assigned
Jun 26, 2006
Last updated
Nov 23, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2009

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

Authorized official

Name
Dr. Stuart Jacob, DPMNPI 1538156963
Title
President
Phone
(609) 386-0217

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X MD01892 NJ Primary

Addresses

Primary practice location

319 W Broad St
Burlington, NJ 08016-1343

Mailing address

319 W Broad St
Burlington, NJ 08016-1343
Phone (609) 386-0217

Other identifiers 8

IdentifierTypeStateIssuer
2093185000OtherINDEPENDENCE BLUE SHIELD
5486906MedicaidNJ
2093185000OtherAMERIHEALTH
2093185000OtherKEYSTONE HEALTH PLAN EAST
2093185000OtherINDEPENDENCE BLUE SHIELD PERSONAL CHOICE
480033923OtherPALMETTO MEDICARE
7159901MedicaidNJ
6324401MedicaidNJ

National Provider Directory

National Provider Directory

Locations

319 W Broad St
Burlington, NJ 08016
Phone (609) 386-0217

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1942236278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 W BROAD ST",
            "city": "BURLINGTON",
            "state": "NJ",
            "postal_code": "080161343",
            "telephone_number": "609-386-0217",
            "fax_number": "609-386-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 W BROAD ST",
            "city": "BURLINGTON",
            "state": "NJ",
            "postal_code": "080161343",
            "telephone_number": "609-386-0217",
            "fax_number": "609-386-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STUART JACOB DPM PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "STUART",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "609-386-0217",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NJ",
            "license": "MD01892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE SHIELD",
            "identifier": "2093185000",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5486906",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "2093185000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HEALTH PLAN EAST",
            "identifier": "2093185000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE SHIELD PERSONAL CHOICE",
            "identifier": "2093185000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO MEDICARE",
            "identifier": "480033923",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7159901",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6324401",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.