Provider Demographics
NPI:1346328713
Name:NEIDERMAN, GEORGE GEOFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GEOFFREY
Last Name:NEIDERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3915 AVENUE V
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5156
Mailing Address - Country:US
Mailing Address - Phone:718-252-8440
Mailing Address - Fax:718-252-6490
Practice Address - Street 1:3915 AVENUE V
Practice Address - Street 2:SUITE 104
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5156
Practice Address - Country:US
Practice Address - Phone:718-252-8440
Practice Address - Fax:718-252-6490
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184789207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100144295602OtherAMERICHOICE
NYP00603271OtherRAILROAD MEDICARE PTAN
NYP867408OtherOXFORD
NYP00000206898OtherGHI
NY02714810OtherMAGNACARE
NY000917442OtherAMERICAN POSTAL WORKERS UNION
NYPR78617270001OtherCIGNA
NY01562101Medicaid
NY0812634OtherAETNA
NY01562101Medicaid
NYP00603271OtherRAILROAD MEDICARE PTAN
NY01562101Medicaid