Provider Demographics
NPI:1679380232
Name:CITER, JACOB ISAIAH (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ISAIAH
Last Name:CITER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 AMSTERDAM AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3307
Mailing Address - Country:US
Mailing Address - Phone:973-868-8174
Mailing Address - Fax:
Practice Address - Street 1:217 BROOK AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3357
Practice Address - Country:US
Practice Address - Phone:973-303-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02064200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation