Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | MC5675 | NJ |
NPI | 1912021205 |
---|---|
Provider Name | Dr. Bruce M Jacobson |
First Address | Union, NJ 07083-5341 |
Second Address | Union, NJ 07083-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |