Provider Demographics
NPI:1780020131
Name:NELSON, ALAN BRADLEY
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:BRADLEY
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BROAD ST
Mailing Address - Street 2:STE L1
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072-1029
Mailing Address - Country:US
Mailing Address - Phone:212-490-6200
Mailing Address - Fax:866-345-2451
Practice Address - Street 1:330 BROAD ST
Practice Address - Street 2:STE L1
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072-1029
Practice Address - Country:US
Practice Address - Phone:212-490-6200
Practice Address - Fax:866-345-2451
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor