Healthcare Provider Details

I. General information

NPI: 1093768467
Provider Name (Legal Business Name): MICHAEL J NESHEIWAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 ROUTE 6 BREWSTER CARMEL PROF BLDG
BREWSTER NY
10509-2527
US

IV. Provider business mailing address

2424 ROUTE 6 BREWSTER CARMEL PROF BLDG
BREWSTER NY
10509-2527
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-2720
  • Fax: 845-278-9795
Mailing address:
  • Phone: 845-278-2720
  • Fax: 845-278-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number186733
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: