Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | ME145463 | FL |
NPI | 1245680636 |
---|---|
Provider Name | Jason Mohel Epstein |
First Address | Philadelphia, PA 19107-4430 |
Second Address | Winter Garden, FL 34787-4767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2016 |
Last Update Date | 14/02/2022 |