Provider Demographics
NPI:1750527859
Name:CERVERA, JASON (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CERVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 BOULEVARD
Mailing Address - Street 2:BOX 569
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-2202
Mailing Address - Country:US
Mailing Address - Phone:908-812-0000
Mailing Address - Fax:
Practice Address - Street 1:335 BOULEVARD
Practice Address - Street 2:BOX 569
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-2202
Practice Address - Country:US
Practice Address - Phone:908-812-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-21
Last Update Date:2008-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ284238490238409208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC48550Medicare PIN