Provider Demographics
NPI:1063729689
Name:MICKAIL, NARDEEN (MD)
Entity type:Individual
Prefix:
First Name:NARDEEN
Middle Name:
Last Name:MICKAIL
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 1:14 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3472
Mailing Address - Country:US
Mailing Address - Phone:631-689-5400
Mailing Address - Fax:631-689-8247
Practice Address - Street 1:14 TECHNOLOGY DR
Practice Address - Street 2:SUITE 10
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3472
Practice Address - Country:US
Practice Address - Phone:631-689-5400
Practice Address - Fax:631-689-8247
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine