Healthcare Provider Details

I. General information

NPI: 1396899902
Provider Name (Legal Business Name): NICOLAS A. NELKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 MOANALUA RD
HONOLULU HI
96819-1469
US

IV. Provider business mailing address

3288 MOANALUA RD
HONOLULU HI
96819-1469
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-0000
  • Fax:
Mailing address:
  • Phone: 808-432-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD-12257
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: