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General NPI Number Information
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NPI Number | 1578848123
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Entity Type | Organization
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Legal Business Name | ELECTROPHYSIOLOGIC MEDICAL DIAGNOSTICS, PC
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 146 ALEXANDER AVE
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City | HARTSDALE
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State | NY
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Zip | 10530-1802
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Country | US
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Telephone | 914-907-5846
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Fax |
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Provider Business Mailing Address
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Address Line | 146 ALEXANDER AVE
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City | HARTSDALE
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State | NY
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Zip | 10530-1802
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Country | US
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Telephone | 914-907-5846
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DINA S NELSON
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Credential | M.D.
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Telephone | 914-907-5846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 198383
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License Number State | NY
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