Healthcare Provider Details

I. General information

NPI: 1962378935
Provider Name (Legal Business Name): MRN DENTAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W 54TH ST STE 1D
NEW YORK NY
10019-5404
US

IV. Provider business mailing address

25 W 54TH ST STE 1D
NEW YORK NY
10019-5404
US

V. Phone/Fax

Practice location:
  • Phone: 212-757-3745
  • Fax: 212-757-3792
Mailing address:
  • Phone: 212-757-3745
  • Fax: 212-757-3792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW ROBERT NADLER
Title or Position: PRESIDENT
Credential: DDS
Phone: 212-757-3745