Healthcare Provider Details

I. General information

NPI: 1093352460
Provider Name (Legal Business Name): JASON A PETER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 COLGATE AVE
PARAMUS NJ
07652-4332
US

IV. Provider business mailing address

90 COLGATE AVE
PARAMUS NJ
07652-4332
US

V. Phone/Fax

Practice location:
  • Phone: 201-245-1625
  • Fax:
Mailing address:
  • Phone: 201-245-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: