Healthcare Provider Details

I. General information

NPI: 1609154111
Provider Name (Legal Business Name): JASON M LUSZCZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MAIN ST
SPRINGFIELD MA
01107-1113
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-8777
  • Fax: 413-794-8226
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA4348
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: