Provider Demographics
NPI:1194818880
Name:NEZARIA, YEHUDA (DPM)
Entity Type:Individual
Prefix:DR
First Name:YEHUDA
Middle Name:
Last Name:NEZARIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BRAYTON COURT SOUTH
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720
Mailing Address - Country:US
Mailing Address - Phone:516-887-2820
Mailing Address - Fax:516-887-2638
Practice Address - Street 1:2000 N VILLAGE AVE STE 207
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1001
Practice Address - Country:US
Practice Address - Phone:516-887-2820
Practice Address - Fax:516-887-2638
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005500213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7677235OtherATENA USHC
NY005500OtherHIP
NY1925334OtherUNITED HEALTH CARE
NY2C6586OtherHEALTH NET
NYCIGNAOther5134279003
NY1499885OtherGHI
NY97964OtherVYTRA HEALTH PLAN
NYPB0411OtherBC & BS
NYBP0412OtherBC& BS
NYP1887381OtherOXFORD
NY2C6586OtherHEALTH NET
NY1499885OtherGHI
NY1925334OtherUNITED HEALTH CARE
NYPB0412Medicare ID - Type Unspecified