Individual
DR. JASON LEE FIDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 996-2000
Mailing address
205 W 15TH ST APT 5U, NEW YORK, NY 10011-6422
(401) 491-7289
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MB10659000
NJ
207P00000X
Emergency Medicine Physician
303940
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0739367
—
NJ
Enumeration date
06/05/2017
Last updated
05/26/2023
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