Healthcare Provider Details

I. General information

NPI: 1063631307
Provider Name (Legal Business Name): SYLVAIN NAKKAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 HILL BLVD
JEFFERSON VALLEY NY
10535-1501
US

IV. Provider business mailing address

3651 HILL BLVD
JEFFERSON VALLEY NY
10535-1501
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-0688
  • Fax: 914-243-5895
Mailing address:
  • Phone: 914-962-0688
  • Fax: 914-243-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number176349
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: