Provider Demographics
NPI:1164629143
Name:NIENALTOW, MARVIN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:DANIEL
Last Name:NIENALTOW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11 RIVERSIDE DR
Mailing Address - Street 2:2A-W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2504
Mailing Address - Country:US
Mailing Address - Phone:212-721-7574
Mailing Address - Fax:914-591-0074
Practice Address - Street 1:11 RIVERSIDE DR
Practice Address - Street 2:2A-W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2504
Practice Address - Country:US
Practice Address - Phone:212-721-7574
Practice Address - Fax:914-591-0074
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1509802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17038Medicare UPIN