Provider Demographics
NPI:1760643654
Name:OLAECHEA, JASOR (MD)
Entity Type:Individual
Prefix:
First Name:JASOR
Middle Name:
Last Name:OLAECHEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JASOR
Other - Middle Name:
Other - Last Name:OLAECHEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:300 COMMUNITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-562-2945
Mailing Address - Fax:
Practice Address - Street 1:9128 84TH ST
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2929
Practice Address - Country:US
Practice Address - Phone:718-570-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2017-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255877208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist