Provider Demographics
NPI:1730723750
Name:LE VERE, JASON CHARLES
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CHARLES
Last Name:LE VERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JASON CHARLES
Other - Middle Name:ALCORIZA
Other - Last Name:LE VERE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8635 QUEENS BLVD APT 3S
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4438
Mailing Address - Country:US
Mailing Address - Phone:831-207-6154
Mailing Address - Fax:
Practice Address - Street 1:214 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4846
Practice Address - Country:US
Practice Address - Phone:212-337-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012184-01208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation