Individual
JAISON JOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-1339
(570) 271-6259
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
OS018745
PA
207R00000X
Internal Medicine Physician
25MB09104700
NJ
208000000X
Pediatrics Physician
25MB09104700
NJ
Other
Enumeration date
06/06/2008
Last updated
08/31/2020
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