Provider Demographics
NPI:1609859180
Name:IDNANI, NINA S (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:S
Last Name:IDNANI
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 1:10 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5214
Mailing Address - Country:US
Mailing Address - Phone:914-637-3510
Mailing Address - Fax:914-819-0061
Practice Address - Street 1:10 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5214
Practice Address - Country:US
Practice Address - Phone:914-637-3510
Practice Address - Fax:914-819-0061
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207083207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01912330Medicaid
NY01912330Medicaid
NY89A721Medicare PIN
CT050001526Medicare PIN
NY06509ZMedicare PIN
NYG64097Medicare UPIN
NY89A72ZXWW1Medicare PIN
NY89A72YRXP1Medicare PIN
NY89A72ZT5H1Medicare PIN