Provider Demographics
NPI:1497751242
Name:NELSON, ANDREW L (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1594 ROUTE 9
Mailing Address - Street 2:UNIT 6
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-349-8888
Mailing Address - Fax:732-349-8880
Practice Address - Street 1:1594 ROUTE 9
Practice Address - Street 2:UNIT 6
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-349-8888
Practice Address - Fax:732-349-8880
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2010-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06570700207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG79030Medicare UPIN
NJ011836Medicare PIN