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General NPI Number Information
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NPI Number | 1194818880
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Entity Type | Individual
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Provider Name | YEHUDA NEZARIA D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 11/28/2021
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Provider Practice Location Address
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Address Line | 2000 N VILLAGE AVE STE 207
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-1001
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Country | US
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Telephone | 516-887-2820
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Fax | 516-887-2638
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Provider Business Mailing Address
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Address Line | 2 BRAYTON COURT SOUTH
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720
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Country | US
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Telephone | 516-887-2820
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Fax | 516-887-2638
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N005500
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License Number State | NY
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