Provider Demographics
NPI:1710154760
Name:FIDDLER, JOHN BERNARD (NP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BERNARD
Last Name:FIDDLER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W 22ND ST APT 7P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2630
Mailing Address - Country:US
Mailing Address - Phone:646-638-2809
Mailing Address - Fax:
Practice Address - Street 1:360 W 22ND ST APT 7P
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2630
Practice Address - Country:US
Practice Address - Phone:646-638-2809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304117-1364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health