Healthcare Provider Details

I. General information

NPI: 1841479458
Provider Name (Legal Business Name): ALAN J NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 OYSTER BAY RD
EAST NORWICH NY
11732-1051
US

IV. Provider business mailing address

898 OYSTER BAY RD
EAST NORWICH NY
11732-1051
US

V. Phone/Fax

Practice location:
  • Phone: 516-922-6546
  • Fax: 516-922-6811
Mailing address:
  • Phone: 516-922-6546
  • Fax: 516-922-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: