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NPI Code Detail

MEDICARE: NICHOLAS ETHAN MARDER

MEDICARE: NICHOLAS ETHAN MARDER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-21-197111FL

General Provider Information

NPI Number : 1699427971
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS ETHAN MARDER
Provider Business Mailing Address
First Line : 4203 SW HIGH MEADOWS AVE
Second Line :
City : PALM CITY
State : FL
Zip : 34990-3726
Country : US
Telephone Number : 772-222-5560
Fax Number : 844-652-8088
Provider Business Practice Location Address
First Line : 4203 SW HIGH MEADOWS AVE
Second Line :
City : PALM CITY
State : FL
Zip : 34990-3726
Country : US
Telephone Number : 772-222-5560
Fax Number : 844-652-8088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2022
Last Update Date : 01/19/2022

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Directions to “ NICHOLAS ETHAN MARDER ” Practice Location

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