Provider Demographics
NPI:1497831465
Name:SMITH, JASON D (NP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:3674 ROUTE 27, PRINCETON RADIOLOGY ASSOCIATES, P.A.
Mailing Address - Street 2:DEPARTMENT B
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-821-5563
Mailing Address - Fax:732-821-6675
Practice Address - Street 1:3674 ROUTE 27, PRINCETON RADIOLOGY ASSOCIATES, P.A.
Practice Address - Street 2:DEPARTMENT B
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824
Practice Address - Country:US
Practice Address - Phone:732-821-5563
Practice Address - Fax:732-821-6675
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00070100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NO11579400OtherREGISTERED PROF NURSE
NJ26NJ00070100OtherADVANCED PRACTICE NURSE