Provider Demographics
NPI:1104076538
Name:MOHABIR, JASON (MSCCCSLP)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:MOHABIR
Suffix:
Gender:M
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 82ND RD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1422
Mailing Address - Country:US
Mailing Address - Phone:718-575-1991
Mailing Address - Fax:718-360-8957
Practice Address - Street 1:103 82ND RD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1422
Practice Address - Country:US
Practice Address - Phone:718-575-1991
Practice Address - Fax:718-360-8957
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist