Provider Demographics
NPI:1760529663
Name:FAHS, JASON SEAN (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:SEAN
Last Name:FAHS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MORRIS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5600
Mailing Address - Country:US
Mailing Address - Phone:908-688-8628
Mailing Address - Fax:908-688-8696
Practice Address - Street 1:2500 MORRIS AVE STE 200
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5600
Practice Address - Country:US
Practice Address - Phone:908-688-8628
Practice Address - Fax:908-688-8696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAOO8393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ835723OtherACN GROUP
NJ2277478OtherUNITED HEALTHCARE
NJ7373094OtherAETNA
NJ029020Medicare ID - Type Unspecified
NJ7373094OtherAETNA