Provider Demographics
NPI:1568834497
Name:FEKETE, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:FEKETE
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 1:16 WASSMER CT
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5307
Mailing Address - Country:US
Mailing Address - Phone:386-569-6988
Mailing Address - Fax:
Practice Address - Street 1:159 TROUT AVE NAVAL UNDERSEA MEDICAL INSTITUTE
Practice Address - Street 2:BOX 159 NAVSUBASE NLON
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5159
Practice Address - Country:US
Practice Address - Phone:860-694-6454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman