Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 25MA09482800 | NJ |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 25MA09482800 | NJ |
NPI | 1154619500 |
---|---|
Provider Name | Dr. Nina Stella Jacobson |
First Address | Neptune, NJ 07753-4488 |
Second Address | Neptune, NJ 07753-4488 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 30/11/2018 |