Provider Demographics
NPI:1962793620
Name:NELSON, RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:450 CLARKSON AVENUE
Mailing Address - Street 2:SUNY DOWNSTATE MEDICAL CENTER, DEPARTMENT OF RADIOLOGY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:718-771-2597
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:SUNY DOWNSTATE MEDICAL CENTER, DEPT OF RADIOLOGY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-245-2682
Practice Address - Fax:718-771-2597
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA104969002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology