Healthcare Provider Details

I. General information

NPI: 1891108080
Provider Name (Legal Business Name): JASON MEYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 MONTAUK HWY SUITE 1
EAST MORICHES NY
11940-1236
US

IV. Provider business mailing address

516 MONTAUK HWY SUITE 1
EAST MORICHES NY
11940-1236
US

V. Phone/Fax

Practice location:
  • Phone: 631-874-2900
  • Fax: 631-874-2948
Mailing address:
  • Phone: 631-874-2900
  • Fax: 631-874-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306557-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: