Healthcare Provider Details

I. General information

NPI: 1497751242
Provider Name (Legal Business Name): ANDREW L. NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1594 ROUTE 9 UNIT 6
TOMS RIVER NJ
08755
US

IV. Provider business mailing address

1594 ROUTE 9 UNIT 6
TOMS RIVER NJ
08755
US

V. Phone/Fax

Practice location:
  • Phone: 732-349-8888
  • Fax: 732-349-8880
Mailing address:
  • Phone: 732-349-8888
  • Fax: 732-349-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number25MA06570700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: