Provider Demographics
NPI:1619944634
Name:NADLER, LESLIE GARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:GARY
Last Name:NADLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 RANDY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3945
Mailing Address - Country:US
Mailing Address - Phone:516-937-0494
Mailing Address - Fax:516-433-8589
Practice Address - Street 1:32 RANDY LN
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3945
Practice Address - Country:US
Practice Address - Phone:516-937-0494
Practice Address - Fax:516-433-8589
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV26471Medicare ID - Type Unspecified