Provider Demographics
NPI:1295459501
Name:JASON S. APPLEBAUM, MD, PC
Entity type:Organization
Organization Name:JASON S. APPLEBAUM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLEBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-696-3923
Mailing Address - Street 1:104 CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:812-461-0425
Practice Address - Street 1:500 N BROADWAY
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2127
Practice Address - Country:US
Practice Address - Phone:917-696-3954
Practice Address - Fax:812-461-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty