Provider Demographics
NPI:1912268301
Name:NALIYATH, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:NALIYATH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1870 N LAWNWOOD CIR
Mailing Address - Street 2:STE A
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4828
Mailing Address - Country:US
Mailing Address - Phone:772-461-0820
Mailing Address - Fax:772-461-0823
Practice Address - Street 1:1870 N LAWNWOOD CIR
Practice Address - Street 2:STE A
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4828
Practice Address - Country:US
Practice Address - Phone:772-461-0820
Practice Address - Fax:772-461-0823
Is Sole Proprietor?:No
Enumeration Date:2012-06-02
Last Update Date:2016-03-17
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Provider Licenses
StateLicense IDTaxonomies
NYFR04356691332084P0800X
FLME1242132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015580200Medicaid
FLIJ156YMedicare PIN