Provider Demographics
NPI:1609691724
Name:JONES, DANTE KHALID (CPRS)
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:KHALID
Last Name:JONES
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243-245 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3395
Mailing Address - Country:US
Mailing Address - Phone:973-399-7900
Mailing Address - Fax:973-399-1705
Practice Address - Street 1:1344 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-5846
Practice Address - Country:US
Practice Address - Phone:973-399-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ50833175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist