Provider Demographics
NPI:1134765118
Name:NIJJAR, MANPREET K
Entity type:Individual
Prefix:DR
First Name:MANPREET
Middle Name:K
Last Name:NIJJAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 QUEENS ST UNIT 1319
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-7453
Mailing Address - Country:US
Mailing Address - Phone:516-477-0530
Mailing Address - Fax:
Practice Address - Street 1:40 QUEENS ST UNIT 1319
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-7453
Practice Address - Country:US
Practice Address - Phone:516-477-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY769345163W00000X
NY403525363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse