Basic Information
| Provider Information | |||||||||
| NPI: | 1093120032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOBI | ||||||||
| FirstName: | IAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 FRIES MILL RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | TURNERSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080122016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565134124 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 HURFFVILLE CROSS KEYS RD | ||||||||
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| City: | TURNERSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080122453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565134124 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT207584 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25MA10101000 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.