Provider Demographics
NPI:1285941096
Name:MARVIN A NIERENBERG, M.D.,P.C.
Entity type:Organization
Organization Name:MARVIN A NIERENBERG, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:NIERENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-874-6484
Mailing Address - Street 1:15 WEST 81ST STREET
Mailing Address - Street 2:1-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 WEST 81ST STREET
Practice Address - Street 2:1-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6022
Practice Address - Country:US
Practice Address - Phone:212-874-6484
Practice Address - Fax:212-874-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0871882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
903071Medicare PIN
B19943Medicare UPIN