Healthcare Provider Details

I. General information

NPI: 1730140138
Provider Name (Legal Business Name): NADER PAKSIMA D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 1ST AVE SUITE#8U
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

530 1ST AVE SUITE#8U
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-2192
  • Fax: 212-263-0231
Mailing address:
  • Phone: 212-263-2192
  • Fax: 212-263-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number207841
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number207841
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number207841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: