Provider Demographics
NPI:1811159874
Name:N.A.D MEDICAL SERVICES, PLLC
Entity type:Organization
Organization Name:N.A.D MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DESIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-721-0080
Mailing Address - Street 1:32 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3516
Mailing Address - Country:US
Mailing Address - Phone:631-721-0080
Mailing Address - Fax:631-736-1607
Practice Address - Street 1:32 HOWARD DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3516
Practice Address - Country:US
Practice Address - Phone:631-721-0080
Practice Address - Fax:631-736-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243370207RG0300X
NY216602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH6652288Medicare UPIN
NYH98837Medicare UPIN