Provider Demographics
NPI:1184321739
Name:NIGHTWATCH MEDICINE PLLC
Entity type:Organization
Organization Name:NIGHTWATCH MEDICINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NODAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JANAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-643-2513
Mailing Address - Street 1:20 WESTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1823
Mailing Address - Country:US
Mailing Address - Phone:718-454-4356
Mailing Address - Fax:
Practice Address - Street 1:2 DEWBERRY CT
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5655
Practice Address - Country:US
Practice Address - Phone:516-643-2513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07728792Medicaid