Provider Demographics
NPI:1801213798
Name:HERSKO, JASON (OTR/L)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HERSKO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MELISSA CT
Mailing Address - Street 2:129 MELISSA CT
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5848
Mailing Address - Country:US
Mailing Address - Phone:718-753-6951
Mailing Address - Fax:
Practice Address - Street 1:129 MELISSA CT
Practice Address - Street 2:129 MELISSA CT
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5848
Practice Address - Country:US
Practice Address - Phone:718-753-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00642500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist