Provider Demographics
NPI:1184817660
Name:N. HARVEY HIMELSTEIN MD LLC
Entity Type:Organization
Organization Name:N. HARVEY HIMELSTEIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:HIMELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-253-8303
Mailing Address - Street 1:6320 FERGUSON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1763
Mailing Address - Country:US
Mailing Address - Phone:317-253-8303
Mailing Address - Fax:317-259-9274
Practice Address - Street 1:6320 FERGUSON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1763
Practice Address - Country:US
Practice Address - Phone:317-253-8303
Practice Address - Fax:317-259-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020452A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty