Provider Demographics
NPI:1598781791
Name:JASINSKI, JOHN MATTHEW (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MATTHEW
Last Name:JASINSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 MAIN AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-810-4151
Mailing Address - Fax:203-810-4150
Practice Address - Street 1:761 MAIN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1080
Practice Address - Country:US
Practice Address - Phone:203-810-4151
Practice Address - Fax:203-810-4150
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970001067Medicare ID - Type Unspecified
P61729Medicare UPIN