Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JASON GANNON, D.P.M.
Active Sole ProprietorJASON GANNON, D.P.M. is a Foot Surgery Podiatrist healthcare provider located in NEWARK, New Jersey. NPI 1619992690 is currently active in the NPPES registry. Verify at CMS.
Foot Surgery Podiatrist · NEWARK, NJ
Registration Details
- NPI Number
- 1619992690
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 12, 2006 (20.116692297914 yrs)
- Last Updated
- Dec 22, 2010
- License
-
25MD00257500 (NJ)
- Sole Proprietor
- Yes
Practice Information
- Address
-
111 MULBERRY STSUITE 1RNEWARK, NJ, 071024008Browse NJ providers · Browse ZIP 07102
- Phone
- 9738189104
- Primary Specialty
-
Foot Surgery Podiatrist
213ES0131X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.