Provider Demographics
NPI:1710036140
Name:NEHEMIAH, PREM GODIN (MD)
Entity type:Individual
Prefix:DR
First Name:PREM
Middle Name:GODIN
Last Name:NEHEMIAH
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 1:4324 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1917
Mailing Address - Country:US
Mailing Address - Phone:718-229-3014
Mailing Address - Fax:718-428-3262
Practice Address - Street 1:4324 MORGAN ST
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11363-1917
Practice Address - Country:US
Practice Address - Phone:718-229-3014
Practice Address - Fax:718-428-3262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12411Medicare UPIN
NY46364Medicare PIN