Provider Demographics
NPI:1710354378
Name:GONCALVES, JASON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:GONCALVES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BUNN DR
Mailing Address - Street 2:#102
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1968
Mailing Address - Country:US
Mailing Address - Phone:609-683-1010
Mailing Address - Fax:609-917-3569
Practice Address - Street 1:800 BUNN DR
Practice Address - Street 2:#102
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1968
Practice Address - Country:US
Practice Address - Phone:609-683-1010
Practice Address - Fax:609-917-3569
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01624800208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation