Provider Demographics
NPI:1255170122
Name:NIKFARJAM, NAOMI
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:NIKFARJAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1438
Mailing Address - Country:US
Mailing Address - Phone:516-423-2122
Mailing Address - Fax:
Practice Address - Street 1:51 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1438
Practice Address - Country:US
Practice Address - Phone:516-423-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist