Doctor Name: | PHIL JAMES NYDEREK |
NPI Number: | 1194984443 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 103 Ashmoore Drive Greenup, KY - 41144 |
Business Phone Number: | 7408216973 |
Business Fax Number: | 6064731389 |
Mailing Address: | 103 Ashmoore Drive, GREENUP |
State: | KY |
Postal Code: | 41144 |
Phone Number: | 7408216973 |
Fax Number: | 6064731389 |
NPI Enumeration Date: | 06/03/2008 |
NPI Last Update Date: | 05/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171WH0202X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Contractor |
Taxonomy Specialization: | Home Modifications |
Taxonomy Definition: |