Healthcare Provider Details

I. General information

NPI: 1740868157
Provider Name (Legal Business Name): NAYAN SANJIV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE FL 3
BOSTON MA
02118-4001
US

IV. Provider business mailing address

850 HARRISON AVE FL 3
BOSTON MA
02118-4001
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4020
  • Fax:
Mailing address:
  • Phone: 617-414-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1023530
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: