Healthcare Provider Details

I. General information

NPI: 1013441252
Provider Name (Legal Business Name): M NAYEEM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14845 HILLSIDE AVE FL 1
JAMAICA NY
11435-3308
US

IV. Provider business mailing address

14845 HILLSIDE AVE FL 1
JAMAICA NY
11435-3308
US

V. Phone/Fax

Practice location:
  • Phone: 516-476-1641
  • Fax:
Mailing address:
  • Phone: 516-476-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number007092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: