Nissan, Robert S

Nissan, Robert S is an individual health care provider with primary practice located at 325 Main St , Northport NY 11768-1790. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Nissan, Robert S can be contacted via phone (631) 261-4445.

Contact Information

Primary practice address
325 Main St Northport NY 11768-1790
Phone: (631) 261-4445
Fax: (631) 261-3710
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 131824 New York

Profile Details

NPI number 1669479010
LBN Legal business name Nissan, Robert S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2005
Last updated Mar 24th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669479010 NPPES
New York MEDICAID 00590001
New York Other 24A921
New York Other 1C2496
New York Other 0520035
New York Other 442081060
New York Other CP521
New York Other 0065892
New York Other 24A921
New York Other 10263

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