MEDICARE: DR. JASON ROBERT BEHAR D.P.M

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	N005420	NY

General Provider Information

NPI Number	:	1861492878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON ROBERT BEHAR D.P.M

Provider Business Mailing Address
First Line	:	671 MONTAUK HWY
Second Line	:
City	:	BAYPORT
State	:	NY
Zip	:	11705-1607
Country	:	US
Telephone Number	:	631-472-2112
Fax Number	:	631-472-2605

Provider Business Practice Location Address
First Line	:	671 MONTAUK HWY
Second Line	:
City	:	BAYPORT
State	:	NY
Zip	:	11705-1607
Country	:	US
Telephone Number	:	631-472-2112
Fax Number	:	631-472-2605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	03/10/2011

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