Provider Demographics
NPI:1235223124
Name:FIEDLER, NANCY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:FIEDLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 STATE ROUTE 18
Mailing Address - Street 2:EAST BRUNSWICK PROFESSIONAL PARK
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1913
Mailing Address - Country:US
Mailing Address - Phone:732-246-8110
Mailing Address - Fax:732-445-0130
Practice Address - Street 1:223 STATE ROUTE 18
Practice Address - Street 2:EAST BRUNSWICK PROFESSIONAL PARK
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1913
Practice Address - Country:US
Practice Address - Phone:732-246-8110
Practice Address - Fax:732-445-0130
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00189000103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35SI00189000OtherNJ LICENSE
NJ35SI00189000OtherNJ LICENSE