Basic Information
| Provider Information | |||||||||
| NPI: | 1346328713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEIDERMAN | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | GEOFFREY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3915 AVENUE V | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112345156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182528440 | ||||||||
| FaxNumber: | 7182526490 | ||||||||
| Practice Location | |||||||||
| Address1: | 3915 AVENUE V | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112345156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182528440 | ||||||||
| FaxNumber: | 7182526490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/21/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 184789 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 100144295602 | 01 | NY | AMERICHOICE | OTHER | P00603271 | 01 | NY | RAILROAD MEDICARE PTAN | OTHER | P867408 | 01 | NY | OXFORD | OTHER | P00000206898 | 01 | NY | GHI | OTHER | 02714810 | 01 | NY | MAGNACARE | OTHER | 000917442 | 01 | NY | AMERICAN POSTAL WORKERS UNION | OTHER | PR78617270001 | 01 | NY | CIGNA | OTHER | 01562101 | 05 | NY | MEDICAID | 0812634 | 01 | NY | AETNA | OTHER |