Provider Demographics
NPI:1003962226
Name:MIKHAEL, NAHED A (MD)
Entity type:Individual
Prefix:DR
First Name:NAHED
Middle Name:A
Last Name:MIKHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:231 KELLY BLVD
Mailing Address - Street 2:STATEN ISLAND
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6008
Mailing Address - Country:US
Mailing Address - Phone:718-238-3201
Mailing Address - Fax:718-238-3202
Practice Address - Street 1:7510 4TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3200
Practice Address - Country:US
Practice Address - Phone:718-238-3201
Practice Address - Fax:718-238-3202
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY229720208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02047661Medicaid