MEDICARE: JEREMY NIKFARJAM MD PC

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1881218857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEREMY NIKFARJAM MD PC

Provider Business Mailing Address
First Line	:	6C BLUE SEA LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 NORTHERN BLVD FL 2
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1502
Country	:	US
Telephone Number	:	516-695-9344
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	JEREMY SAUL NIKFARJAM
Credential	:	MD
Telephone Number	:	516-695-9344

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	01/25/2023

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