Provider Demographics
NPI:1235246380
Name:NISHBALL, EDWARD R (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:NISHBALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 RIDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-4238
Mailing Address - Country:US
Mailing Address - Phone:845-473-2285
Mailing Address - Fax:845-473-4378
Practice Address - Street 1:1421 ROUTE 44
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7832
Practice Address - Country:US
Practice Address - Phone:845-635-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0070641103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist