Provider Demographics
NPI:1861492878
Name:BEHAR, JASON ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:BEHAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1607
Mailing Address - Country:US
Mailing Address - Phone:631-472-2112
Mailing Address - Fax:631-472-2605
Practice Address - Street 1:671 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1607
Practice Address - Country:US
Practice Address - Phone:631-472-2112
Practice Address - Fax:631-472-2605
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005420213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU70810Medicare UPIN
PA3051Medicare ID - Type Unspecified