Provider Demographics
NPI:1982789228
Name:VENGELIS, JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:VENGELIS
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 1:1247 HWY 36
Mailing Address - Street 2:
Mailing Address - City:UNION BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-3519
Mailing Address - Country:US
Mailing Address - Phone:732-619-1656
Mailing Address - Fax:
Practice Address - Street 1:1247 HWY 36
Practice Address - Street 2:
Practice Address - City:UNION BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07735-3519
Practice Address - Country:US
Practice Address - Phone:732-619-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00578500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU99948Medicare UPIN
NJ079578SQ5Medicare ID - Type Unspecified