Healthcare Provider Details

I. General information

NPI: 1194818880
Provider Name (Legal Business Name): YEHUDA NEZARIA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/28/2021
Certification Date: 11/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 N VILLAGE AVE STE 207
ROCKVILLE CENTRE NY
11570-1001
US

IV. Provider business mailing address

2 BRAYTON COURT SOUTH
SOUTH SETAUKET NY
11720
US

V. Phone/Fax

Practice location:
  • Phone: 516-887-2820
  • Fax: 516-887-2638
Mailing address:
  • Phone: 516-887-2820
  • Fax: 516-887-2638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005500
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: