Healthcare Provider Details

I. General information

NPI: 1073560066
Provider Name (Legal Business Name): JONATHAN DAVID RHOADS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WESCOTT DRIVE SUITE G-3
FLEMINGTON NJ
08822
US

IV. Provider business mailing address

1100 WESCOTT DRIVE SUITE G-3
FLEMINGTON NJ
08822
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-1710
  • Fax: 908-788-1716
Mailing address:
  • Phone: 908-788-1710
  • Fax: 908-788-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00168700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00168700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: