Provider Demographics
NPI:1821314766
Name:NIERENBURG, HIDA DEL CARMEN (M D)
Entity Type:Individual
Prefix:
First Name:HIDA
Middle Name:DEL CARMEN
Last Name:NIERENBURG
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:HIDA
Other - Middle Name:DEL CARMEN
Other - Last Name:BENERO RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1351 ROUTE 55 STE 200
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5128
Mailing Address - Country:US
Mailing Address - Phone:845-475-9661
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:21 READE PL STE 1100
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3986
Practice Address - Country:US
Practice Address - Phone:845-214-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT654402084N0400X
NY2773802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04329677Medicaid