Healthcare Provider Details

I. General information

NPI: 1831269950
Provider Name (Legal Business Name): NELLY KATSNELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - DEPT. OF PSYCHIATRY 111 EAST 210TH STREET, KLAU 1
BRONX NY
10467
US

IV. Provider business mailing address

525 E 89TH ST
NEW YORK NY
10128-7834
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4295
  • Fax:
Mailing address:
  • Phone: 718-920-4295
  • Fax: 718-920-6538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number177524
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: