Provider Demographics
NPI:1033538772
Name:NEMELIVSKY, MARIA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NEMELIVSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89-56 162ND STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:JAMACIA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5072
Mailing Address - Country:US
Mailing Address - Phone:718-657-1100
Mailing Address - Fax:718-657-1870
Practice Address - Street 1:751 BRIGGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-5501
Practice Address - Country:US
Practice Address - Phone:845-647-2000
Practice Address - Fax:845-647-2302
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0579451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04450208Medicaid