Healthcare Provider Details

I. General information

NPI: 1831196187
Provider Name (Legal Business Name): BERNARD JAY NASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MONTAUK HWY STE S
WEST ISLIP NY
11795-4420
US

IV. Provider business mailing address

500 MONTAUK HWY STE S
WEST ISLIP NY
11795-4420
US

V. Phone/Fax

Practice location:
  • Phone: 631-587-7733
  • Fax: 631-587-7798
Mailing address:
  • Phone: 631-587-7733
  • Fax: 631-587-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number145915
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: