Provider Demographics
NPI:1750619581
Name:JASON HALEGOUA, M.D., P.C.
Entity type:Organization
Organization Name:JASON HALEGOUA, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEGOUA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD, MBA
Authorized Official - Phone:516-650-3636
Mailing Address - Street 1:11 LILY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2001
Mailing Address - Country:US
Mailing Address - Phone:516-650-3636
Mailing Address - Fax:
Practice Address - Street 1:207 HALLOCK RD STE 106
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3075
Practice Address - Country:US
Practice Address - Phone:631-675-9777
Practice Address - Fax:631-675-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231789208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty