Basic Information
Provider Information
NPI: 1548516065
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HENDLER
FirstName: NOAH
MiddleName: L
NamePrefix: MR.
NameSuffix:  
Credential: APRN, FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3115 REDDING RD
Address2:  
City: FAIRFIELD
State: CT
PostalCode: 068241611
CountryCode: US
TelephoneNumber: 9175192944
FaxNumber:  
Practice Location
Address1: 2800 MAIN ST
Address2:  
City: BRIDGEPORT
State: CT
PostalCode: 066064201
CountryCode: US
TelephoneNumber: 2035766000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/02/2012
LastUpdateDate: 08/02/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X10.087299CTN Nursing Service ProvidersRegistered Nurse 
363LF0000X12.005051CTY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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