IndividualActive
Jason Gannon, D.P.M.
NPI 1619992690 · Foot Surgery Podiatrist · Newark, NJ
Provider details
- NPI number
- 1619992690
- Entity type
- Individual
- Primary specialty
- Foot Surgery PodiatristPodiatric Medicine & Surgery Service Providers
- Credential
- D.P.M.
- Sex
- Male
- Sole proprietor
- Yes
- License
- 25MD00257500 (NJ)
Specialties & taxonomies
Podiatric Medicine & Surgery Service Providers
Practice location
111 Mulberry St
Suite 1r
Newark, NJ 07102-4008
Phone: (973) 818-9104
Approximate (ZIP-level) locationGet directions
Mailing address
131 Safran Ave
Edison, NJ 08837-3205
Registry dates
- Enumerated
- 2006-07-12
- Last updated
- 2010-12-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.