Provider Demographics
NPI:1821394628
Name:NAGELBERG, MICHAEL PAUL (DOCTOR OF PODIATRY)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:NAGELBERG
Suffix:
Gender:M
Credentials:DOCTOR OF PODIATRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3906
Mailing Address - Country:US
Mailing Address - Phone:718-768-4529
Mailing Address - Fax:718-768-0595
Practice Address - Street 1:284 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3906
Practice Address - Country:US
Practice Address - Phone:718-768-4529
Practice Address - Fax:718-768-0595
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006458213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03480146Medicaid