Provider Demographics
NPI:1215096375
Name:JONATHAN L. NELSON, M.D., P.C.
Entity type:Organization
Organization Name:JONATHAN L. NELSON, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-251-9110
Mailing Address - Street 1:33 CEDAR ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2031
Mailing Address - Country:US
Mailing Address - Phone:914-251-9110
Mailing Address - Fax:914-921-4877
Practice Address - Street 1:33 CEDAR ST
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2031
Practice Address - Country:US
Practice Address - Phone:914-251-9110
Practice Address - Fax:914-921-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222467207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEF231Medicare PIN