Provider Demographics
NPI:1578676136
Name:NAKHJAVAN, JEFFREY (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:NAKHJAVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6014
Mailing Address - Country:US
Mailing Address - Phone:631-242-1181
Mailing Address - Fax:631-242-1372
Practice Address - Street 1:1400 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1618
Practice Address - Country:US
Practice Address - Phone:631-242-1181
Practice Address - Fax:631-242-1372
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02187300Medicaid
NY02187300Medicaid
NY21V731Medicare PIN