Provider Demographics
NPI:1164635017
Name:ROUMI, NESSIM (MD)
Entity Type:Individual
Prefix:DR
First Name:NESSIM
Middle Name:
Last Name:ROUMI
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 1:2522 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3916
Mailing Address - Country:US
Mailing Address - Phone:718-934-8182
Mailing Address - Fax:718-934-3111
Practice Address - Street 1:2522 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3916
Practice Address - Country:US
Practice Address - Phone:718-934-8182
Practice Address - Fax:718-934-3111
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173-545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0008212OtherAETNA
NY3C0273OtherPHS
NY173545A-15Other1199
NYP555155OtherOXFORD
NY0012820OtherGHI
NY35E301Medicare ID - Type Unspecified
NY0008212OtherAETNA