Healthcare Provider Details

I. General information

NPI: 1205111655
Provider Name (Legal Business Name): DENIS NANKERVIS JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 W MONTAUK HWY
HAMPTON BAYS NY
11946-3551
US

IV. Provider business mailing address

185 OLD COUNTRY RD STE 3
RIVERHEAD NY
11901-2121
US

V. Phone/Fax

Practice location:
  • Phone: 631-728-0393
  • Fax: 631-728-0394
Mailing address:
  • Phone: 631-298-4479
  • Fax: 631-591-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number289148-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: