Provider Demographics
NPI:1538903224
Name:PATNICK, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PATNICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MINE RD
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-3706
Mailing Address - Country:US
Mailing Address - Phone:609-218-8128
Mailing Address - Fax:
Practice Address - Street 1:110 MINE RD
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-3706
Practice Address - Country:US
Practice Address - Phone:609-218-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician