=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376691774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANLEY H. NADULEK, PH.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 06/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4068 MOUNT ROYAL BLVD STE 218
-----------------------------------------------------
City | ALLISON PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15101-2951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-487-1710
-----------------------------------------------------
Fax | 724-444-3047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4068 MOUNT ROYAL BLVD STE 218
-----------------------------------------------------
City | ALLISON PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15101-2951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-487-1710
-----------------------------------------------------
Fax | 724-444-3047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STANLEY HOWARD NADULEK
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 412-487-1710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PS-005306-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS-005306-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------