Provider Demographics
NPI:1518092055
Name:NELSON, YVONNE (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LINCOLN HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3963
Mailing Address - Country:US
Mailing Address - Phone:732-494-4500
Mailing Address - Fax:732-494-2818
Practice Address - Street 1:3 LINCOLN HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3963
Practice Address - Country:US
Practice Address - Phone:732-494-4500
Practice Address - Fax:732-494-2818
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08175100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I71965Medicare UPIN