Provider Demographics
NPI:1588602460
Name:NEMAT, EJAZ (MD)
Entity Type:Individual
Prefix:
First Name:EJAZ
Middle Name:
Last Name:NEMAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CHIMNEY CORNER LN
Mailing Address - Street 2:SUITE 2022
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4800
Mailing Address - Country:US
Mailing Address - Phone:561-345-3997
Mailing Address - Fax:866-602-5987
Practice Address - Street 1:224 CHIMNEY CORNER LN
Practice Address - Street 2:SUITE 2022
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4800
Practice Address - Country:US
Practice Address - Phone:561-345-3997
Practice Address - Fax:866-602-5987
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43303OtherBCBS
FL269662200Medicaid
FL43303OtherBCBSFL PIN #
FL43303AMedicare PIN
FL43303OtherBCBS
FL43303OtherBCBSFL PIN #