MEDICARE: NOURISH MEDICAL GROUP, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1770442766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISH MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	257 PARK AVE S FL 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-7304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 S FLOWER ST # 1015
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90071-2201
Country	:	US
Telephone Number	:	512-693-7045
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AJAY HARYANI
Credential	:
Telephone Number	:	815-954-4829

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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