Provider Demographics
NPI:1093946618
Name:NIELSEN, ERIC T III (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:NIELSEN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10150-0158
Mailing Address - Country:US
Mailing Address - Phone:646-558-3613
Mailing Address - Fax:716-242-1912
Practice Address - Street 1:227 E 56TH ST RM 203
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3733
Practice Address - Country:US
Practice Address - Phone:646-558-3613
Practice Address - Fax:716-242-1912
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253850207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology