Provider Demographics
NPI:1295782399
Name:NISSIEM, HANY G (MD)
Entity type:Individual
Prefix:
First Name:HANY
Middle Name:G
Last Name:NISSIEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6565 FOURTH SECTION RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2416
Mailing Address - Country:US
Mailing Address - Phone:585-395-0620
Mailing Address - Fax:585-395-0622
Practice Address - Street 1:6565 FOURTH SECTION RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2416
Practice Address - Country:US
Practice Address - Phone:585-395-0620
Practice Address - Fax:585-395-0622
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2016-05-24
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Provider Licenses
StateLicense IDTaxonomies
NY227675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA6621Medicare ID - Type Unspecified