Provider Demographics
NPI:1043393010
Name:EPSTEIN, NATHANIEL BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:BERNARD
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 HEMPSTEAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:516-593-3541
Mailing Address - Fax:516-593-5482
Practice Address - Street 1:158 HEMPSTEAD AVENUE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-593-3541
Practice Address - Fax:516-599-8307
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161867207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01078739Medicaid
NY01078739Medicaid
NY20E4103931Medicare PIN
NY20E411Medicare ID - Type Unspecified