Provider Demographics
NPI:1972082394
Name:LEVINE, JASON ADAM (DPT)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ADAM
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 KINGSLAND TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1468
Mailing Address - Country:US
Mailing Address - Phone:732-616-4502
Mailing Address - Fax:
Practice Address - Street 1:261 KINGSLAND TER
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1468
Practice Address - Country:US
Practice Address - Phone:732-616-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01802000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation