Provider Demographics
NPI:1659465524
Name:KLOBY, JASON MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:KLOBY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 ROUTE 202/206
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1777
Mailing Address - Country:US
Mailing Address - Phone:908-722-0808
Mailing Address - Fax:908-722-7645
Practice Address - Street 1:766 ROUTE 202/206
Practice Address - Street 2:SUITE 1
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1777
Practice Address - Country:US
Practice Address - Phone:908-722-0808
Practice Address - Fax:908-722-7645
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00067600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ068975Medicare ID - Type Unspecified
NJP23563Medicare UPIN