Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jason Gannon, DPM

Individual provider Foot Surgery Podiatrist · NPI 1619992690

Jason Gannon, DPM is a Podiatry in Newark, New Jersey. Graduated from New York College of Podiatric Medicine in 1997, 29 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in New Jersey.

Years since qualifying
29
Trained at
New York College of Podiatric Medicine
Licensed in
NJ
In the registry since
2006
What do these letters mean?
DPM — Doctor of Podiatric Medicine
A foot and ankle physician and surgeon.

See every abbreviation used in this directory →

Practice location Address checks out

111 Mulberry St Ste 1R
Newark, NJ 07102-4008
Phone: (973) 818-9104
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Foot Surgery Podiatrist (primary) Taxonomy 213ES0131X · Licence 25MD00257500 (NJ)

Record details

NPI number1619992690
Entity typeIndividual (Type 1)
GenderMale
Credentials DPM
Sole proprietorYes
NPI enumeratedJuly 12, 2006
Last updated in NPPESDecember 22, 2010
Mailing address131 Safran Ave, Edison, NJ 08837-3205

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPODIATRY
Medical schoolNEW YORK COLLEGE OF PODIATRIC MEDICINE
Graduated 1997 (29 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount