Phil James Nyderek Sr.

Primary specialty

Home Modifications ContractorTaxonomy code 171WH0202X

Practice address

103 Ashmoore Drive
Greenup, KY 41144

Phone

(740) 821-6973

Fax

(606) 473-1389

NPI assigned

Jun 3, 2008

Last updated

May 12, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431388800000",
    "number": "1194984443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 ASHMOORE DRIVE",
            "city": "GREENUP",
            "state": "KY",
            "postal_code": "41144",
            "telephone_number": "740-821-6973",
            "fax_number": "606-473-1389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 ASHMOORE DRIVE",
            "city": "GREENUP",
            "state": "KY",
            "postal_code": "41144",
            "telephone_number": "740-821-6973",
            "fax_number": "606-473-1389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYDEREK",
        "first_name": "PHIL",
        "middle_name": "JAMES",
        "name_suffix": "Sr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-03",
        "last_updated": "2015-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171WH0202X",
            "taxonomy_group": "",
            "desc": "Contractor, Home Modifications",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2778632",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandi Morris
• Kristin Morris
• Richard Bradley Morris, O.D.
• Alice Nauman
• Kendra N Newman
• Dante R Oreta, M.D.
• Karen Jean Osborne, R.D.
• Stephanie Osborne
• William Pack
• Mary Palmer, RN

• Home Modifications Contractor in Greenup, KY
• Providers in Greenup, KY by specialty
• Home Modifications Contractor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.