Provider Demographics
NPI:1487236816
Name:FRASIER, JASON DAVID
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:FRASIER
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 1:1508 STATE HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-4328
Mailing Address - Country:US
Mailing Address - Phone:518-225-9894
Mailing Address - Fax:
Practice Address - Street 1:909 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4267
Practice Address - Country:US
Practice Address - Phone:860-444-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164237700000X
MEDL389237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist