Healthcare Provider Details

I. General information

NPI: 1629694708
Provider Name (Legal Business Name): BILLEL DJEMIL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE # 2A31
NEW YORK NY
10029-7494
US

IV. Provider business mailing address

1901 1ST AVE # 2A31
NEW YORK NY
10029-7494
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number320248-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number320248-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number320248-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: