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Individual
ROBERT S NISSAN
Active
Individual
ROBERT S NISSAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
131824
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00590001
—
NY
01
—
0065892
GHI
—
01
—
0520035
AETNA
—
01
—
10263
VYTRA
—
01
—
1C2496
HEALTHNET
—
01
—
24A921
MEDICARE LEGACY
NY
01
—
442081060
MEDICARE RAILROAD PTAN
NY
01
—
CP521
OXFORD
—
Enumeration date
06/30/2005
Last updated
03/24/2010
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