Provider Demographics
NPI:1962112938
Name:NIGHTWATER HEALTH OF NEW YORK, PC
Entity type:Organization
Organization Name:NIGHTWATER HEALTH OF NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:IKEMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-717-3050
Mailing Address - Street 1:1 BLACKFORD DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4623
Mailing Address - Country:US
Mailing Address - Phone:504-717-3050
Mailing Address - Fax:504-617-6371
Practice Address - Street 1:501 5TH AVE RM 1203
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-7872
Practice Address - Country:US
Practice Address - Phone:917-620-2633
Practice Address - Fax:504-617-6371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY320401-01OtherNY BOARD OF MEDICINE