Provider Demographics
NPI:1780891655
Name:NIERENBERG, MARVIN ALFRED (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:ALFRED
Last Name:NIERENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15 W 81ST ST
Mailing Address - Street 2:1-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6022
Mailing Address - Country:US
Mailing Address - Phone:212-874-6484
Mailing Address - Fax:212-874-0104
Practice Address - Street 1:15 W 81ST ST
Practice Address - Street 2:1-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6022
Practice Address - Country:US
Practice Address - Phone:212-874-6484
Practice Address - Fax:212-874-0104
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0871881-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
903071Medicare PIN
NYB 19943Medicare UPIN