Provider Demographics
NPI:1134298474
Name:BAYPORT PODIATRY CARE, P.C.
Entity Type:Organization
Organization Name:BAYPORT PODIATRY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-472-2112
Mailing Address - Street 1:671 MONTAUK HWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1627
Mailing Address - Country:US
Mailing Address - Phone:631-472-2112
Mailing Address - Fax:631-472-2605
Practice Address - Street 1:671 MONTAUK HWY UNIT B
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1627
Practice Address - Country:US
Practice Address - Phone:631-472-2112
Practice Address - Fax:631-472-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005420213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01877623Medicaid
NYPA3051Medicare ID - Type Unspecified
NYU70810Medicare UPIN