Provider Demographics
NPI:1053382465
Name:GOLBIN, JASON M (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:GOLBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8415
Mailing Address - Country:US
Mailing Address - Phone:631-666-5806
Mailing Address - Fax:
Practice Address - Street 1:370 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-0001
Practice Address - Country:US
Practice Address - Phone:631-666-5806
Practice Address - Fax:631-666-1187
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47922207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
I44297Medicare UPIN
MN290000494Medicare ID - Type Unspecified