Healthcare Provider Details

I. General information

NPI: 1336229368
Provider Name (Legal Business Name): KAREN R NELSON M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 7TH AVE
NEW YORK NY
10001-6708
US

IV. Provider business mailing address

275 7TH AVE
NEW YORK NY
10001-6708
US

V. Phone/Fax

Practice location:
  • Phone: 212-924-2510
  • Fax: 212-812-3614
Mailing address:
  • Phone: 212-924-2510
  • Fax: 212-812-3614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number201217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: