Provider Demographics
NPI:1548229818
Name:LOO, NELLY T (MD)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:T
Last Name:LOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:198 CANAL STREET
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-267-7200
Mailing Address - Fax:212-962-4402
Practice Address - Street 1:198 CANAL STREET
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-267-7200
Practice Address - Fax:212-962-4402
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY174767207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
1492032OtherPHCS
043675OtherUNITED HEALTHCAREMEDICARE
273507OtherWELLCARE ENDO SPECIALIST
0M463POtherHIP
133685785OtherHEALTH NET
133685785OtherMULTIPLAN
1537194OtherUNITED HEALTHCARE
NP560OtherOXFORD
2502050OtherGHI
133685785OtherHORIZON HEALTH CARE
246015812OtherGHI UNITE
273472OtherWELLCARE
13G681OtherBLUE CROSS BLUE SHIELD
7158021OtherCIGNA PPO
M4071OtherVYTRA
NY01500747Medicaid
133685785Other1199 BENEFIT PLAN
13G681OtherBLUE CROSS BLUE SHIELD
1492032OtherPHCS