person
Jason Gannon, DPM
Foot Surgery Podiatrist in Newark, New Jersey
NPI 1619992690

Jason Gannon is a Foot Surgery Podiatrist based in Edison, NJ and is specialized in Foot Surgery. 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 (New Jersey).

The current practice location address for Jason Gannon is 111 Mulberry St, Newark, NJ and can be reached out via phone at 973-818-9104. You can also correspond with Jason Gannon through the mailing address at 131 SAFRAN AVE, EDISON, NJ - 08837-3205 (mailing address contact number: 973-818-9104).

Location: 111 Mulberry St, Newark, NJ, 08837-3205
person
Provider Profile Details
NPI Number
1619992690
Provider Name
Jason Gannon
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
111 Mulberry St, Newark, NJ, 08837-3205
Phone Number
973-818-9104
Fax Number
Provider Enumeration Date
07/12/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
8238502 05 NJ
institution
Provider Business Practice Location Address Details
Address
111 Mulberry St
City
State
Zip
07102-4008
Phone Number
973-818-9104
Fax Number
person
Provider Business Mailing Address Details
Address
111 Mulberry St
City
State
Zip
07102-4008
Phone Number
973-818-9104
Fax Number
person
Provider's Taxonomy Details 1
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Foot Surgery
Taxonomy
License No.
25MD00257500 (New Jersey)
Definition
Definition to come...
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