Provider Demographics
NPI:1013305101
Name:RODKER, JASON D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:RODKER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1945
Mailing Address - Country:US
Mailing Address - Phone:973-378-5525
Mailing Address - Fax:973-378-5590
Practice Address - Street 1:90 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1945
Practice Address - Country:US
Practice Address - Phone:973-378-5525
Practice Address - Fax:973-378-5590
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ143-050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical