Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MB09905600 | NJ |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | OS13338 | FL |
NPI | 1053750299 |
---|---|
Provider Name | Dr. Jason Georgekutty |
First Address | The Woodlands, TX 77380-1480 |
Second Address | Chester, NJ 07930-2141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 22/01/2021 |