Provider Demographics
NPI:1336344951
Name:NANCY C. NITENSON MD LLC
Entity Type:Organization
Organization Name:NANCY C. NITENSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:NITENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-850-9005
Mailing Address - Street 1:TEN POST OFFICE SQUARE
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109
Mailing Address - Country:US
Mailing Address - Phone:617-850-9005
Mailing Address - Fax:617-850-9006
Practice Address - Street 1:TEN POST OFFICE SQUARE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109
Practice Address - Country:US
Practice Address - Phone:617-850-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ10803Medicare ID - Type Unspecified
E76200Medicare UPIN