Provider Demographics
NPI:1598829475
Name:DR EDGAR H NIETER PA
Entity type:Organization
Organization Name:DR EDGAR H NIETER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:NIETER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-941-1200
Mailing Address - Street 1:1661 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6750
Mailing Address - Country:US
Mailing Address - Phone:954-941-1200
Mailing Address - Fax:954-942-4005
Practice Address - Street 1:1661 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6750
Practice Address - Country:US
Practice Address - Phone:954-941-1200
Practice Address - Fax:954-942-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2132213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390191200Medicaid
FLCB2016OtherRAILROAD MEDICARE
FL77441OtherBCBS
FL77441OtherBCBS
U33358Medicare UPIN
FL390191200Medicaid