Provider Demographics
NPI:1144290438
Name:AUMACK, JASON (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:AUMACK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 HIGHWAY 35
Mailing Address - Street 2:BLDG A
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1013
Mailing Address - Country:US
Mailing Address - Phone:732-974-0404
Mailing Address - Fax:732-974-2653
Practice Address - Street 1:2164 HIGHWAY 35
Practice Address - Street 2:BLDG A
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1013
Practice Address - Country:US
Practice Address - Phone:732-974-0404
Practice Address - Fax:732-974-2653
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00115200363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ39811Medicare UPIN
NJ089420BC1Medicare ID - Type Unspecified