Provider Demographics
NPI:1073669735
Name:NIDERMAN, FLORA (DDS)
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:
Last Name:NIDERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 FULTON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5314
Mailing Address - Country:US
Mailing Address - Phone:718-624-6204
Mailing Address - Fax:718-222-0427
Practice Address - Street 1:585 FULTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-624-6204
Practice Address - Fax:718-222-0427
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04851911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02237805Medicaid