1386811164 NPI number — JASON GLENN DARAS DO

Table of content: JASON GLENN DARAS DO (NPI 1386811164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386811164 NPI number — JASON GLENN DARAS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARAS
Provider First Name:
JASON
Provider Middle Name:
GLENN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386811164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STONY BROOK UNIVERSITY HOSPITAL
Provider Second Line Business Mailing Address:
MEDICAL STAFF OFFICE T-14
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794-7148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-444-2754
Provider Business Mailing Address Fax Number:
631-444-6031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DIAMOND HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY HEIGHTS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-277-8872
Provider Business Practice Location Address Fax Number:
908-673-7382
Provider Enumeration Date:
05/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 25MB08737600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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