1194818880 NPI number — DR. YEHUDA NEZARIA D.P.M.

Table of content: DR. YEHUDA NEZARIA D.P.M. (NPI 1194818880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194818880 NPI number — DR. YEHUDA NEZARIA D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEZARIA
Provider First Name:
YEHUDA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1194818880
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 BRAYTON COURT SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH SETAUKET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-887-2820
Provider Business Mailing Address Fax Number:
516-887-2638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 N VILLAGE AVE STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE CENTRE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11570-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-887-2820
Provider Business Practice Location Address Fax Number:
516-887-2638
Provider Enumeration Date:
10/02/2006

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: 213ES0131X , with the licence number:  N005500 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7677235 . This is a "ATENA USHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 005500 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1925334 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C6586 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "5134279003" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1499885 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 97964 . This is a "VYTRA HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PB0411 . This is a "BC & BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: BP0412 . This is a "BC& BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1887381 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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