| Doctor Name: | MR. THEODORE R NADELEN |
| NPI Number: | 1144391962 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, RN, FNP |
| License Number: | 334787-1 |
| Business Practice Address: | 77 S Main St Lyndonville, NY - 140989771 |
| Business Phone Number: | 5857652060 |
| Business Fax Number: | 5857652067 |
| Mailing Address: | 300 West Ave, BROCKPORT |
| State: | NY |
| Postal Code: | 144201118 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 02/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 334787-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |