Jason Gannon, DPM
Healthcare Provider in Newark, New Jersey
1619992690- Practice location
- 111 Mulberry St, Suite 1R, Newark, NJ 07102-4008
- Phone
- 973-818-9104
- Fax
- —
- Last updated
- December 22, 2010
Jason Gannon is a Healthcare Provider based in Newark, NJ. Jason Gannon practices in Newark, NJ and has the professional credentials of DPM. The NPI Number for Jason Gannon is 1619992690 and holds a License No. 25MD00257500 (NJ). The current practice location address for Jason Gannon is 111 Mulberry St, Suite 1R, Newark, NJ 07102-4008 and can be reached out via phone at 973-818-9104.
Provider Profile Details
- NPI Number
- 1619992690
- Provider Name
- Jason Gannon
- Credential
- DPM
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 111 Mulberry St, Suite 1R, Newark, NJ 07102-4008
- Phone Number
- 973-818-9104
- Primary Taxonomy
- Healthcare Provider · 213ES0131X
- Sole Proprietor
- Yes
- Provider Enumeration Date
- July 12, 2006
- Last Update Date
- December 22, 2010
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 111 Mulberry St
Suite 1R
Newark, NJ 07102-4008 - City
- Newark
- State
- New Jersey
- Zip
- 07102-4008
- Phone Number
- 973-818-9104
Provider Business Mailing Address Details
- Address
- 131 Safran Ave
Edison, NJ 08837-3205 - City
- Edison
- State
- NJ
- Zip
- 08837-3205
- Phone Number
- 973-818-9104
License Information
- License Number
- 25MD00257500
- License State
- NJ
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Jason Gannon, DPM?
The NPI number of Jason Gannon, DPM is 1619992690. It was assigned on July 12, 2006 and is currently active in the NPPES registry.
What is the specialty of Jason Gannon, DPM?
Jason Gannon, DPM is registered under the primary taxonomy Healthcare Provider (code 213ES0131X), licensed in NJ under license number 25MD00257500.
Where does Jason Gannon, DPM practice?
The practice location is 111 Mulberry St, Suite 1R, Newark, NJ 07102-4008. The office can be reached at 973-818-9104 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1619992690 directly on the NPPES registry website.