Provider Demographics
NPI:1477622009
Name:NADLER, JERRY L
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:NADLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE STE 3100N
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9028
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-909-6900
Practice Address - Fax:914-493-2828
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296348207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE94981Medicare UPIN
VAPAROtherUSA MANAGED CARE
VA0270634OtherCIGNA
VA10033430OtherSENTARA/OPTIMA
VAPAROtherMULTIPLAN
VAMC10036Medicare PIN
VA4277681OtherAETNA
NC5909038Medicaid
NC09038OtherNC BC/BS
VAPAROtherVA PREMIER HEALTH
VAPAROtherCORVEL/CORCARE
VAE94981Medicare UPIN
VA1477622009Medicaid
VA-033OtherTRICARE/CHAMPUS
VAPAROtherVA HEALTH NETWORK
VA348932OtherANTHEM - BRAMBLETON OFFICE
VAPAROtherFIRST HEALTH COMMERCIAL