Provider Demographics
NPI:1053379073
Name:NOORDZIJ, JACOB PIETER (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:PIETER
Last Name:NOORDZIJ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 HARRISON AVE STE 1400
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-638-8124
Practice Address - Fax:617-414-4953
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2024-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA81945207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1053379073Medicaid
NH3116032Medicaid
RIJN72402Medicaid
MA110073822AMedicaid