Provider Demographics
NPI:1336214022
Name:PAPE, JASON IAN (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:IAN
Last Name:PAPE
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5733
Mailing Address - Country:US
Mailing Address - Phone:631-664-2781
Mailing Address - Fax:631-670-6730
Practice Address - Street 1:66 AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5733
Practice Address - Country:US
Practice Address - Phone:631-664-2781
Practice Address - Fax:631-858-2901
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-008815111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMX6Y471Medicare UPIN