Provider Demographics
NPI:1255425948
Name:MENEZES, NELSON SOCORRO (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:SOCORRO
Last Name:MENEZES
Suffix:
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 1:75 88TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-238-2249
Mailing Address - Fax:718-250-8460
Practice Address - Street 1:186 JORALEMON ST
Practice Address - Street 2:SUITE 1002
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4356
Practice Address - Country:US
Practice Address - Phone:718-625-4100
Practice Address - Fax:718-625-4900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1949482086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20-8604768OtherEMPLOYER IDENTIFICATION N
NY01788783Medicaid
NYG11414Medicare UPIN
NY97E2 31Medicare ID - Type Unspecified