Healthcare Provider Details

I. General information

NPI: 1407089956
Provider Name (Legal Business Name): JEFFREY D. NIGHTINGALE, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 BROADWAY STE 1410
NEW YORK NY
10019-2007
US

IV. Provider business mailing address

1776 BROADWAY STE 1410
NEW YORK NY
10019-2007
US

V. Phone/Fax

Practice location:
  • Phone: 212-877-7188
  • Fax:
Mailing address:
  • Phone: 212-877-7188
  • Fax: 212-877-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number118287
License Number StateNY

VIII. Authorized Official

Name: ANDREW BRADLEY NIGHTINGALE
Title or Position: MANAGER
Credential: MD
Phone: 212-877-7188