Healthcare Provider Details

I. General information

NPI: 1952513079
Provider Name (Legal Business Name): NITIN J ENGINEER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 SEVEN HILLS DR STE 210
HENDERSON NV
89052-4380
US

IV. Provider business mailing address

880 SEVEN HILLS DR STE 210
HENDERSON NV
89052-4380
US

V. Phone/Fax

Practice location:
  • Phone: 702-907-2222
  • Fax: 702-907-4444
Mailing address:
  • Phone: 702-907-2222
  • Fax: 702-907-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number41501
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number125-045179
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number41501
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number40241
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number13102
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: