Healthcare Provider Details

I. General information

NPI: 1962466623
Provider Name (Legal Business Name): ELIZABETH E NADLER ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 OLD MILITARY RD USOC SPORTS MEDICINE
LAKE PLACID NY
12946-1940
US

IV. Provider business mailing address

PO BOX 1258
LAKE PLACID NY
12946-5258
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-8438
  • Fax: 518-523-4808
Mailing address:
  • Phone: 518-523-8438
  • Fax: 518-523-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000778-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: