Provider Demographics
NPI:1679738991
Name:SARGIS, JASON MICHAEL (DAOM)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:SARGIS
Suffix:
Gender:M
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1921
Mailing Address - Country:US
Mailing Address - Phone:973-910-1441
Mailing Address - Fax:877-642-1441
Practice Address - Street 1:388 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1814
Practice Address - Country:US
Practice Address - Phone:973-910-1441
Practice Address - Fax:877-642-1441
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00062600171100000X
NY003850171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist