Provider Demographics
NPI:1124026505
Name:NEJAT, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:NEJAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4198
Mailing Address - Country:US
Mailing Address - Phone:516-741-2255
Mailing Address - Fax:516-741-2456
Practice Address - Street 1:300 OLD COUNTRY RD
Practice Address - Street 2:SUITE 211
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4198
Practice Address - Country:US
Practice Address - Phone:516-741-2255
Practice Address - Fax:516-741-2456
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY206073208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02195077Medicaid
NYH39483Medicare UPIN
3S3301Medicare ID - Type Unspecified