Provider Demographics
NPI:1538387964
Name:KATZ, JACOB (MD)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 US HIGHWAY 9 STE 1
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9209
Mailing Address - Country:US
Mailing Address - Phone:732-762-5005
Mailing Address - Fax:732-410-4676
Practice Address - Street 1:74 US HIGHWAY 9 STE 1
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9209
Practice Address - Country:US
Practice Address - Phone:732-762-5005
Practice Address - Fax:732-410-4676
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10151200207QS0010X
FLME 126965207QS0010X
NY286279207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine