Individual
JONATHAN EDWARD FASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
053 MCKINLY LAB, NEWARK, DE 19716
(302) 831-8893
Mailing address
053 MCKINLY LAB, NEWARK, DE 19716
(302) 831-8893
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
J1-0002475
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J1-0002475
STATE OF DELAWARE
DE
Enumeration date
06/09/2009
Last updated
06/09/2009
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