Healthcare Provider Details

I. General information

NPI: 1306823190
Provider Name (Legal Business Name): BINYOMIN MENDEL NEMON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 CROWN ST APT 611
BROOKLYN NY
11213-5358
US

IV. Provider business mailing address

694 MYRTLE AVE PMB # 180
BROOKLYN NY
11205-3916
US

V. Phone/Fax

Practice location:
  • Phone: 845-791-9277
  • Fax: 845-468-5860
Mailing address:
  • Phone: 845-791-9277
  • Fax: 845-791-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number211250
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: