Provider Demographics
NPI:1346505658
Name:NISCHAL MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NISCHAL MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:NISCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-499-6963
Mailing Address - Street 1:1756 ALADDIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4012
Mailing Address - Country:US
Mailing Address - Phone:516-498-7838
Mailing Address - Fax:516-352-0740
Practice Address - Street 1:172 HERRICKS RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2206
Practice Address - Country:US
Practice Address - Phone:516-499-6963
Practice Address - Fax:516-352-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty