Provider Demographics
NPI:1851848162
Name:NELSON, SCOTT EDWIN
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:EDWIN
Last Name:NELSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2545
Mailing Address - Country:US
Mailing Address - Phone:212-677-6788
Mailing Address - Fax:646-692-8808
Practice Address - Street 1:179 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2545
Practice Address - Country:US
Practice Address - Phone:212-677-6788
Practice Address - Fax:646-692-8808
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2025-04-08
Deactivation Date:2025-03-28
Deactivation Code:
Reactivation Date:2025-04-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant