Provider Demographics
NPI:1891971867
Name:JASON'S SENSORY GYM
Entity Type:Organization
Organization Name:JASON'S SENSORY GYM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-HEAD OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:BERNATH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:201-833-4587
Mailing Address - Street 1:1183 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3529
Mailing Address - Country:US
Mailing Address - Phone:201-833-4587
Mailing Address - Fax:
Practice Address - Street 1:1183 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3529
Practice Address - Country:US
Practice Address - Phone:201-833-4587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00155200225XP0200X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty