Provider Demographics
NPI:1750440111
Name:NEIL NIREN, MD, PC
Entity type:Organization
Organization Name:NEIL NIREN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-367-0808
Mailing Address - Street 1:9102 BABCOCK BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5819
Mailing Address - Country:US
Mailing Address - Phone:412-367-0808
Mailing Address - Fax:412-366-1584
Practice Address - Street 1:9102 BABCOCK BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5819
Practice Address - Country:US
Practice Address - Phone:412-367-0808
Practice Address - Fax:412-366-1584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAN1396464207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017113660003Medicaid
PA0017113660003Medicaid