Healthcare Provider Details

I. General information

NPI: 1730001264
Provider Name (Legal Business Name): JEAN NEKEL FILS DARIUS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W WOODSIDE AVE
PATCHOGUE NY
11772-1161
US

IV. Provider business mailing address

120 W WOODSIDE AVE
PATCHOGUE NY
11772-1161
US

V. Phone/Fax

Practice location:
  • Phone: 631-992-5993
  • Fax:
Mailing address:
  • Phone: 631-992-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN48831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: