Provider Demographics
NPI:1609531573
Name:YUAN, JASON (ND)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:YUAN
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1833
Mailing Address - Country:US
Mailing Address - Phone:646-318-3892
Mailing Address - Fax:
Practice Address - Street 1:43 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1833
Practice Address - Country:US
Practice Address - Phone:646-318-3892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT702175F00000X
NJ25MZ00157100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath