Provider Demographics
NPI:1700350261
Name:NIERENBERG ASSOCIATES,PA
Entity Type:Organization
Organization Name:NIERENBERG ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:NIERENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-310-9997
Mailing Address - Street 1:32531 N SCOTTSDALE RD STE 105-213
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1519
Mailing Address - Country:US
Mailing Address - Phone:601-310-9997
Mailing Address - Fax:480-488-9839
Practice Address - Street 1:1800 E VAN BUREN ST # 605
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3742
Practice Address - Country:US
Practice Address - Phone:602-251-8316
Practice Address - Fax:480-333-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ279981200OtherMEDICAID
AZ279981200Medicaid