Doctor Name: | JASON CERVERA |
NPI Number: | 1750527859 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 284238490238409 |
Business Practice Address: | 335 Boulevard Box 569 Elmwood Park, NJ - 074072202 |
Business Phone Number: | 9088120000 |
Business Fax Number: | |
Mailing Address: | 335 Boulevard, Box 569 ELMWOOD PARK |
State: | NJ |
Postal Code: | 074072202 |
Phone Number: | 9088120000 |
Fax Number: | |
NPI Enumeration Date: | 12/21/2008 |
NPI Last Update Date: | 12/21/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 284238490238409 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |