Provider Demographics
NPI:1316941776
Name:ENG, NELSON (DO)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:ENG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5209
Mailing Address - Country:US
Mailing Address - Phone:718-896-0229
Mailing Address - Fax:718-960-3635
Practice Address - Street 1:470 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5108
Practice Address - Country:US
Practice Address - Phone:718-960-3805
Practice Address - Fax:718-960-3806
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1348576Medicaid
NY76K60Medicare ID - Type Unspecified
NY1348576Medicaid