Provider Demographics
NPI:1205876844
Name:NADLER, IRVING MARTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:IRVING
Middle Name:MARTIN
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 1:500 S OCEAN BLVD
Mailing Address - Street 2:APT. 1803
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-6263
Mailing Address - Country:US
Mailing Address - Phone:561-447-4078
Mailing Address - Fax:561-368-7791
Practice Address - Street 1:4400 N FEDERAL HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5187
Practice Address - Country:US
Practice Address - Phone:561-361-0711
Practice Address - Fax:561-361-0811
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6695AMedicare ID - Type Unspecified
FLQ60250Medicare UPIN