Provider Demographics
NPI:1124119706
Name:HALPER, JASON (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:HALPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6715
Mailing Address - Country:US
Mailing Address - Phone:718-339-9398
Mailing Address - Fax:718-677-5735
Practice Address - Street 1:1917 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6801
Practice Address - Country:US
Practice Address - Phone:718-677-9100
Practice Address - Fax:718-677-5735
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190269-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01712101Medicaid
NY190269-1OtherNY STATE LICENSE & REGIST
NY190269-1OtherNY STATE LICENSE & REGIST
NY01712101Medicaid
NYG39325Medicare UPIN