Provider Demographics
NPI:1689855314
Name:OOMMEN, JAISON (PT, MS)
Entity Type:Individual
Prefix:MR
First Name:JAISON
Middle Name:
Last Name:OOMMEN
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1205
Mailing Address - Country:US
Mailing Address - Phone:917-975-3757
Mailing Address - Fax:732-234-6634
Practice Address - Street 1:18 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1205
Practice Address - Country:US
Practice Address - Phone:917-975-3757
Practice Address - Fax:732-234-6634
Is Sole Proprietor?:No
Enumeration Date:2007-11-22
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027753225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics