Provider Demographics
NPI:1245328103
Name:NELSON, JOHN MARTIN JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARTIN
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2535
Mailing Address - Country:US
Mailing Address - Phone:914-967-8708
Mailing Address - Fax:914-967-5834
Practice Address - Street 1:3010 WESTCHESTER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2535
Practice Address - Country:US
Practice Address - Phone:914-967-8708
Practice Address - Fax:914-967-5834
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150073207X00000X, 207XP3100X
CT28357207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00970338Medicaid
NY00970338Medicaid
A62671Medicare UPIN
CT200001076Medicare ID - Type Unspecified
NY41D791Medicare Oscar/Certification