Provider Demographics
NPI:1578503538
Name:NIEDER, ALAN
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:NIEDER
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 1:4300 ALTON RD
Mailing Address - Street 2:ASCHER BUILDING ,2ND FLOOR
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2800
Mailing Address - Country:US
Mailing Address - Phone:305-674-3977
Mailing Address - Fax:305-535-7919
Practice Address - Street 1:4306 ALTON RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2840
Practice Address - Country:US
Practice Address - Phone:305-674-2499
Practice Address - Fax:305-674-2899
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87075208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273054500Medicaid
16239ZMedicare ID - Type Unspecified
I09949Medicare UPIN