Basic Information
Provider Information
NPI: 1003140369
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NADEL
FirstName: SHARI
MiddleName: ILISE
NamePrefix: MISS
NameSuffix:  
Credential: MPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 437 E 71ST ST
Address2: APT. 3FW
City: NEW YORK
State: NY
PostalCode: 100214841
CountryCode: US
TelephoneNumber: 9178164403
FaxNumber:  
Practice Location
Address1: 147 W 35TH ST
Address2: SUITE 407
City: NEW YORK
State: NY
PostalCode: 100012110
CountryCode: US
TelephoneNumber: 9175918494
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/18/2009
LastUpdateDate: 09/18/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X029863-1NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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