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General NPI Number Information
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NPI Number | 1801600630
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Entity Type | Organization
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Legal Business Name | NY FAMILY HEALTH NP SERVICES PC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 6333 98TH PL APT 3C
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City | REGO PARK
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State | NY
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Zip | 11374-2317
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Country | US
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Telephone | 718-415-5494
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Fax |
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Provider Business Mailing Address
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Address Line | 7925 150TH ST APT A20
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City | FLUSHING
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State | NY
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Zip | 11367-3803
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Country | US
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Telephone | 718-415-5494
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MR. YAKOV NISIMOV
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Credential | FNP
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Telephone | 718-415-5494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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