Provider Demographics
NPI:1063616589
Name:NELSON MENEZES VASCULAR SPECIALIST PC
Entity type:Organization
Organization Name:NELSON MENEZES VASCULAR SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MENEZES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-250-6237
Mailing Address - Street 1:75 88TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5523
Mailing Address - Country:US
Mailing Address - Phone:718-250-6237
Mailing Address - Fax:718-238-2249
Practice Address - Street 1:240 WILLOUGHBY ST
Practice Address - Street 2:5A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5465
Practice Address - Country:US
Practice Address - Phone:718-250-6237
Practice Address - Fax:718-250-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1949482086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWFM901Medicare PIN