Provider Demographics
NPI:1124063219
Name:NISIMOVA, MERI (MD)
Entity type:Individual
Prefix:DR
First Name:MERI
Middle Name:
Last Name:NISIMOVA
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 1:8900 VAN WYCK EXPY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2832
Mailing Address - Country:US
Mailing Address - Phone:718-206-7160
Mailing Address - Fax:718-206-7169
Practice Address - Street 1:8900 VAN WYCK EXPY
Practice Address - Street 2:DEPT. OF PSYCHIATRY
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2832
Practice Address - Country:US
Practice Address - Phone:718-206-7160
Practice Address - Fax:718-206-7169
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2352572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02673201Medicaid
NY0206FFMedicare PIN
NYI41202Medicare UPIN