Provider Demographics
NPI:1881763332
Name:NEMIROVSKY, NATAN I (MD)
Entity type:Individual
Prefix:DR
First Name:NATAN
Middle Name:I
Last Name:NEMIROVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2813
Mailing Address - Country:US
Mailing Address - Phone:215-856-7140
Mailing Address - Fax:215-856-7136
Practice Address - Street 1:11500 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2813
Practice Address - Country:US
Practice Address - Phone:215-856-7140
Practice Address - Fax:215-856-7136
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040780E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011556530016Medicaid
PAF06009Medicare UPIN
PANE644428Medicare ID - Type Unspecified