Provider Demographics
NPI:1053561977
Name:PALERMO, JASON (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PALERMO
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:120 WHITE HORSE PIKE
Mailing Address - Street 2:STE 112
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1938
Mailing Address - Country:US
Mailing Address - Phone:856-547-0539
Mailing Address - Fax:856-796-9183
Practice Address - Street 1:2309 E EVESHAM RD
Practice Address - Street 2:SUITES 201 & 202
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1559
Practice Address - Country:US
Practice Address - Phone:856-325-5400
Practice Address - Fax:856-325-5416
Is Sole Proprietor?:No
Enumeration Date:2008-09-27
Last Update Date:2017-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC10009115207RC0000X
PAMD427910207RC0000X
NJ25MA08882300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0260461Medicaid
NJ215054YBAWMedicare PIN