=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205876844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRVING MARTIN NADLER PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 08/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4400 N FEDERAL HWY SUITE 201
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-5187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-361-0711
-----------------------------------------------------
Fax | 561-361-0811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 S OCEAN BLVD APT. 1803
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-6263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-447-4078
-----------------------------------------------------
Fax | 561-368-7791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY7113
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------