=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962378935
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MRN DENTAL P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2025
-----------------------------------------------------
Last Update Date | 10/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 W 54TH ST STE 1D
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-757-3745
-----------------------------------------------------
Fax | 212-757-3792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 W 54TH ST STE 1D
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-757-3745
-----------------------------------------------------
Fax | 212-757-3792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MATTHEW ROBERT NADLER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 212-757-3745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------