Provider Demographics
NPI:1821121138
Name:MITTLEMAN, JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:MITTLEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 TILTON RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1235
Mailing Address - Country:US
Mailing Address - Phone:609-484-8776
Mailing Address - Fax:609-484-8336
Practice Address - Street 1:950 TILTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1235
Practice Address - Country:US
Practice Address - Phone:609-484-8776
Practice Address - Fax:609-484-8336
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ020949Medicare UPIN