Provider Demographics
NPI:1174676951
Name:MONSEUR, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MONSEUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1329
Mailing Address - Country:US
Mailing Address - Phone:570-693-3001
Mailing Address - Fax:570-693-3023
Practice Address - Street 1:904 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1329
Practice Address - Country:US
Practice Address - Phone:570-693-3001
Practice Address - Fax:570-693-3023
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012115210001Medicaid
PA1012115210001Medicaid