MEDICARE: JASON CHARLES LE VERE

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	208100000X	Physical Medicine & Rehabilitation Physician	012184-01	NY

General Provider Information

NPI Number	:	1730723750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON CHARLES LE VERE

Provider Business Mailing Address
First Line	:	8635 QUEENS BLVD APT 3S
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4438
Country	:	US
Telephone Number	:	831-207-6154
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 W HOUSTON ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-4846
Country	:	US
Telephone Number	:	212-337-9400
Fax Number	:

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

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	11/01/2019

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Directions to “ JASON CHARLES LE VERE ” Practice Location

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