MEDICARE: DR. LARRY M NELSON DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	MD002180	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P3602754	OTHER	NJ	OXFORD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	PA000000100	OTHER	NJ	AMERICHOICE

General Provider Information

NPI Number	:	1831167279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY M NELSON DPM

Provider Business Mailing Address
First Line	:	344 LAFAYETTE AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-2506
Country	:	US
Telephone Number	:	973-238-0660
Fax Number	:	973-238-1003

Provider Business Practice Location Address
First Line	:	344 LAFAYETTE AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-2506
Country	:	US
Telephone Number	:	973-238-0660
Fax Number	:	973-238-1003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	02/01/2010

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