Healthcare Provider Details

I. General information

NPI: 1497580203
Provider Name (Legal Business Name): NIGEL RAMESH KISSOON PUBLIC HEALTH DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 100261 BOX 1
FPO AE
09514-6100
US

IV. Provider business mailing address

UNIT 100261 BOX 1
FPO AE
09514-6100
US

V. Phone/Fax

Practice location:
  • Phone: 718-710-6717
  • Fax: 718-710-6717
Mailing address:
  • Phone: 718-710-6717
  • Fax: 718-710-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number40287
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: