Provider Demographics
NPI:1366405524
Name:LANGLEY, JASEN (DPM)
Entity type:Individual
Prefix:
First Name:JASEN
Middle Name:
Last Name:LANGLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3324
Mailing Address - Country:US
Mailing Address - Phone:732-905-1110
Mailing Address - Fax:732-905-7885
Practice Address - Street 1:4645 HWY 9 NORTH
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3354
Practice Address - Country:US
Practice Address - Phone:732-905-1110
Practice Address - Fax:732-905-7885
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002717213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2420480000OtherAMERIHEALTH
NJ2K8197OtherHEALTHNET
NJ9112502Medicaid
NJP2810436OtherOXFORD
NJ01000709901OtherAMERICHOICE
NJ2420480000OtherAMERIHEALTH