Nikolai Lieders, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

023342 Issued in CT

Practice address

Dutton Home Silver St
River Valley Services
Middletown, CT 06457

Phone

(860) 262-5358

Fax

(860) 262-5356

NPI assigned

Dec 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Charter Oak Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hartford, CT
  • NPI 1992750855
  Medicare reassignment NPD
• State of Connecticut

  dba River Valley Services

  • Adult Mental Health Clinic/Center
  • Middletown, CT
  • NPI 1427074426
  Medicare reassignment NPD
• Charter Oak Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hartford, CT
  • NPI 1841937679
  NPD
• State of Connecticut

  dba Department of Veterans' Affairs, Veterans Home

  • Skilled Nursing Facility
  • Rocky Hill, CT
  • NPI 1205951662
  NPD
• Intercommunity, Inc.

  • Primary Care Clinic/Center
  • East Hartford, CT
  • NPI 1073548533
  NPD (past)
• Intercommunity, Inc.

  • Federally Qualified Health Center (FQHC)
  • East Hartford, CT
  • NPI 1962896548
  NPD (past)

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396813051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 351",
            "address_2": "DUTTON HOME SILVER ST RIVER VALLEY SERVICES",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "06457",
            "telephone_number": "860-262-5358",
            "fax_number": "860-262-5356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DUTTON HOME SILVER ST",
            "address_2": "RIVER VALLEY SERVICES",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "06457",
            "telephone_number": "860-262-5358",
            "fax_number": "860-262-5356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEDERS",
        "first_name": "NIKOLAI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "023342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Lewis, LCSW
• Jonathan Li, MD
• Yu Ying Li, M.S.
• Allyson Leigh Licese
• Brett J Lieberman, N.D.
• Life Changes, LLC
• Lifted, LLC
• Valerie Light, LPC
• Lighthouse Medical Supply, LLC
• Laura Liistro, LCSW

• Psychiatry Physician in Middletown, CT
• Providers in Middletown, CT by specialty
• Psychiatry Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.