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General NPI Number Information
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NPI Number | 1063616589
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Entity Type | Organization
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Legal Business Name | NELSON MENEZES VASCULAR SPECIALIST PC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 240 WILLOUGHBY ST 5A
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City | BROOKLYN
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State | NY
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Zip | 11201-5465
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Country | US
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Telephone | 718-250-6237
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Fax | 718-250-8460
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Provider Business Mailing Address
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Address Line | 75 88TH ST
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City | BROOKLYN
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State | NY
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Zip | 11209-5523
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Country | US
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Telephone | 718-250-6237
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Fax | 718-238-2249
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Authorized Official
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Title or Position | PRESIDENT
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Name | NELSON MENEZES
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Credential | MD
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Telephone | 718-250-6237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 194948
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License Number State | NY
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