Provider Demographics
NPI:1902020621
Name:ALFRED NELSON, MAGALIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGALIE
Middle Name:
Last Name:ALFRED 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 1:19602 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2125
Mailing Address - Country:US
Mailing Address - Phone:718-465-0593
Mailing Address - Fax:718-479-7012
Practice Address - Street 1:19602 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2125
Practice Address - Country:US
Practice Address - Phone:718-465-0593
Practice Address - Fax:718-479-7012
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1921502080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01538641Medicaid