Provider Demographics
NPI:1558517128
Name:NADAN, RICHARD J (MBA, NP)
Entity Type:Individual
Prefix:PROF
First Name:RICHARD
Middle Name:J
Last Name:NADAN
Suffix:
Gender:M
Credentials:MBA, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COMMUNITY DRIVE
Mailing Address - Street 2:NORTH SHORE - LIJ, INFECTIOUS DISEAS
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3815
Mailing Address - Country:US
Mailing Address - Phone:516-562-4280
Mailing Address - Fax:516-562-2626
Practice Address - Street 1:400 COMMUNITY DR
Practice Address - Street 2:NORTH SHORE - LIJ, INFECTIOUS DISEAS
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3815
Practice Address - Country:US
Practice Address - Phone:516-562-4280
Practice Address - Fax:516-562-2626
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430088363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care