Provider Demographics
NPI:1679506745
Name:NINAN, PHILIP MOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MOHAN
Last Name:NINAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:935 NORTHERN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5309
Mailing Address - Country:US
Mailing Address - Phone:516-487-7116
Mailing Address - Fax:516-829-1731
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5309
Practice Address - Country:US
Practice Address - Phone:516-487-7116
Practice Address - Fax:516-829-1731
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2014-01-07
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Provider Licenses
StateLicense IDTaxonomies
NY138802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB16248Medicare UPIN