Healthcare Provider Details

I. General information

NPI: 1861492878
Provider Name (Legal Business Name): JASON ROBERT BEHAR D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 MONTAUK HWY
BAYPORT NY
11705-1607
US

IV. Provider business mailing address

671 MONTAUK HWY
BAYPORT NY
11705-1607
US

V. Phone/Fax

Practice location:
  • Phone: 631-472-2112
  • Fax: 631-472-2605
Mailing address:
  • Phone: 631-472-2112
  • Fax: 631-472-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005420
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: