Provider Demographics
NPI:1740655323
Name:NIERENBERG, YEHUDIS (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:YEHUDIS
Middle Name:
Last Name:NIERENBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5157
Mailing Address - Country:US
Mailing Address - Phone:732-363-0705
Mailing Address - Fax:
Practice Address - Street 1:45 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5157
Practice Address - Country:US
Practice Address - Phone:732-363-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020140172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker