Basic Information
| Provider Information | |||||||||
| NPI: | 1790873891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARKOVITZ | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 ROCKWOOD PL | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076314957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018940003 | ||||||||
| FaxNumber: | 2018940006 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 ROCKWOOD PL | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076314957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018940003 | ||||||||
| FaxNumber: | 2018940006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 05/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 25MA08052400 | NJ | N | Other Service Providers | Legal Medicine | 207V00000X | 25MA08052400 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.