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General NPI Number Information
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NPI Number | 1780727529
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Entity Type | Individual
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Provider Name | JONATHAN D. FREET PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1135 BROAD ST 3RD FL SUITE 3
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City | CLIFTON
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State | NJ
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Zip | 07013-3346
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Country | US
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Telephone | 973-614-0990
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Fax | 973-614-8288
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Provider Business Mailing Address
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Address Line | 20 ALBERTINE PL
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City | OAK RIDGE
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State | NJ
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Zip | 07438-8829
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Country | US
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Telephone | 201-835-7302
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00165500
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License Number State | NJ
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