Healthcare Provider Details

I. General information

NPI: 1447564398
Provider Name (Legal Business Name): DAVID NATHAN DJEBALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST ST 10TH FL, HEALTH CENTER
NEW YORK NY
10282-2102
US

IV. Provider business mailing address

200 WEST ST 10TH FL, HEALTH CENTER
NEW YORK NY
10282-2102
US

V. Phone/Fax

Practice location:
  • Phone: 212-357-6339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA09342200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number263842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: