Provider Demographics
NPI:1205437621
Name:FEAK, JASON PATRICK
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:PATRICK
Last Name:FEAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6338 FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-8799
Mailing Address - Country:US
Mailing Address - Phone:315-761-3266
Mailing Address - Fax:
Practice Address - Street 1:6338 FALLS BLVD
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-8799
Practice Address - Country:US
Practice Address - Phone:315-761-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant