Provider Demographics
NPI:1790461812
Name:NAYYAR, PUSHPAK
Entity type:Individual
Prefix:
First Name:PUSHPAK
Middle Name:
Last Name:NAYYAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 DENISE ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4319
Mailing Address - Country:US
Mailing Address - Phone:516-557-6206
Mailing Address - Fax:
Practice Address - Street 1:1025 PORTION RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2291
Practice Address - Country:US
Practice Address - Phone:631-696-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist