Provider Demographics
NPI:1053714188
Name:DEPASQUALE, JASON (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DEPASQUALE
Suffix:
Gender:
Credentials:PA
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Mailing Address - Street 1:44 PEACHTREE PL NW UNIT 1426
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-5412
Mailing Address - Country:US
Mailing Address - Phone:315-439-3739
Mailing Address - Fax:
Practice Address - Street 1:30 BROAD ST FL 45
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2942
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2025-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY029953363A00000X
363A00000X
NC0010-13873363A00000X
MAPA9383363A00000X
GA7407363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant