Provider Demographics
NPI:1558335141
Name:NADEL, DEARDRE L (DPM, FACFAOM)
Entity Type:Individual
Prefix:DR
First Name:DEARDRE
Middle Name:L
Last Name:NADEL
Suffix:
Gender:F
Credentials:DPM, FACFAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ASPEN RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7301
Mailing Address - Country:US
Mailing Address - Phone:718-918-0021
Mailing Address - Fax:914-722-1747
Practice Address - Street 1:2550 WEBB AVE
Practice Address - Street 2:APT 1H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3930
Practice Address - Country:US
Practice Address - Phone:718-918-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN 3779213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2883947-P2883947OtherOXFORD
NY005149OtherGHI
NY00865614Medicaid
NYP2883947-P2883947OtherOXFORD
NYP3932Medicare ID - Type Unspecified