Provider Demographics
NPI:1417909169
Name:NIETO, JAIME H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:H
Last Name:NIETO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-1837
Mailing Address - Fax:718-661-7186
Practice Address - Street 1:5620 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5046
Practice Address - Country:US
Practice Address - Phone:718-670-1837
Practice Address - Fax:718-661-7186
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226855207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0399798OtherGHI
NYH90500Medicare UPIN