Provider Demographics
NPI:1306823190
Name:NEMON, BINYOMIN MENDEL (DO)
Entity Type:Individual
Prefix:DR
First Name:BINYOMIN
Middle Name:MENDEL
Last Name:NEMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:694 MYRTLE AVE
Mailing Address - Street 2:PMB # 180
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3916
Mailing Address - Country:US
Mailing Address - Phone:845-791-9277
Mailing Address - Fax:845-791-9222
Practice Address - Street 1:580 CROWN ST APT 611
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5358
Practice Address - Country:US
Practice Address - Phone:845-791-9277
Practice Address - Fax:845-468-5860
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02407770Medicaid
75V391Medicare ID - Type Unspecified
NY02407770Medicaid