Provider Demographics
NPI:1922084409
Name:NELSON, MARK A (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:NELSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:360 MERRICK RD FL 1
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2526
Mailing Address - Country:US
Mailing Address - Phone:516-887-3516
Mailing Address - Fax:516-887-0331
Practice Address - Street 1:777 SUNRISE HWY STE 200
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2950
Practice Address - Country:US
Practice Address - Phone:516-887-3516
Practice Address - Fax:516-887-0331
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2024-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1980192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01611150Medicaid
NY8361581OtherCIGNA
NY55653141OtherMULTIPLAN
NYNS0003669OtherSELECT PRO
NY130015649OtherRAILROAD MEDICARE
NY370801OtherBLUE CREOSS BLUE SHIELD
NYOPNN1980191-2OtherWC- NO FAULT
NYP665887OtherOXFORD
NY76673OtherVYTRA
NY640285OtherHERITAGE
NY112573413OtherNO FAULT,WC, OCM,OHP,PHCS
NY2C5246OtherHEALTHNET
NYOPNN1980191-2OtherWC- NO FAULT
NY370801OtherBLUE CREOSS BLUE SHIELD
NYP665887OtherOXFORD
NY112573413OtherUHC, EMPIRE PLAN
NY640285OtherHERITAGE
NYG18755Medicare UPIN
NY370801Medicare ID - Type UnspecifiedMEDICARE