Provider Demographics
NPI:1528612231
Name:JACOBOVITS, STEPHANIE T (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:T
Last Name:JACOBOVITS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 WESTERVELT PL
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4627
Mailing Address - Country:US
Mailing Address - Phone:862-247-9706
Mailing Address - Fax:
Practice Address - Street 1:140 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1471
Practice Address - Country:US
Practice Address - Phone:973-742-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02770700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist