Provider Demographics
NPI:1700113933
Name:NIEDER, JOSEPH MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MARTIN
Last Name:NIEDER
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 1:1556 THIRD AVENUE
Mailing Address - Street 2:SUITE 601A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3100
Mailing Address - Country:US
Mailing Address - Phone:212-876-5406
Mailing Address - Fax:212-876-3503
Practice Address - Street 1:1556 THIRD AVENUE
Practice Address - Street 2:SUITE 601A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3100
Practice Address - Country:US
Practice Address - Phone:212-876-5406
Practice Address - Fax:212-876-3503
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-0951862084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1700113933OtherCMS
NY1700113933OtherCMS
AN4834099OtherDEA