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General NPI Number Information
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NPI Number | 1295220325
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Entity Type | Individual
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Provider Name | JASON TU
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Gender | Male
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Dates
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Enumeration Date | 07/01/2018
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 164 W 96TH ST
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City | NEW YORK
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State | NY
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Zip | 10025-6402
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Country | US
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Telephone | 212-749-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 604 1/2 GROVE ST APT 1
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City | JERSEY CITY
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State | NJ
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Zip | 07310-1290
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Country | US
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Telephone | 646-610-2795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 060663
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License Number State | NY
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