IndividualActive
Ellis Jacobs, PHD
NPI 1720256910 · Diplomate Laboratory Management Specialist/Technologist · Teaneck, NJ
Provider details
- NPI number
- 1720256910
- Entity type
- Individual
- Primary specialty
- Diplomate Laboratory Management Specialist/TechnologistTechnologists, Technicians & Other Technical Service Providers
- Credential
- PHD
- Sex
- Male
- Sole proprietor
- Yes
- License
- JACOE1 (NY)
Practice location
540 Wyndham Rd
Teaneck, NJ 07666-2612
Phone: (201) 836-1518
Fax: (212) 318-4699
Mailing address
540 Wyndham Rd
Teaneck, NJ 07666-2612
Registry dates
- Enumerated
- 2008-02-11
- Last updated
- 2013-07-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.