Provider Demographics
NPI:1760477830
Name:ADER, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:ADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 RIVERDALE AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1845
Mailing Address - Country:US
Mailing Address - Phone:718-543-3636
Mailing Address - Fax:718-884-4885
Practice Address - Street 1:3765 RIVERDALE AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1845
Practice Address - Country:US
Practice Address - Phone:718-543-3636
Practice Address - Fax:718-884-4885
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01015094Medicaid
NYB19696Medicare UPIN
NY85D121Medicare ID - Type Unspecified