Provider Demographics
NPI:1225284946
Name:JOHN, NADIA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:MARY
Last Name:JOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5309
Mailing Address - Country:US
Mailing Address - Phone:516-333-4100
Mailing Address - Fax:
Practice Address - Street 1:990 WESTBURY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5309
Practice Address - Country:US
Practice Address - Phone:516-333-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics