Healthcare Provider Details

I. General information

NPI: 1104515998
Provider Name (Legal Business Name): MICHELLE NOURMAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NORTHERN BLVD STE 220
GREAT NECK NY
11021-5348
US

IV. Provider business mailing address

1000 NORTHERN BLVD STE 220
GREAT NECK NY
11021-5348
US

V. Phone/Fax

Practice location:
  • Phone: 516-636-1533
  • Fax:
Mailing address:
  • Phone: 516-636-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number344435
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: