Provider Demographics
NPI:1396880456
Name:NELSON, HOWARD (PT)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:106 PINEHURST AVE
Mailing Address - Street 2:# C-21
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1716
Mailing Address - Country:US
Mailing Address - Phone:917-509-2870
Mailing Address - Fax:212-568-5872
Practice Address - Street 1:106 PINEHURST AVE
Practice Address - Street 2:# C-21
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-1716
Practice Address - Country:US
Practice Address - Phone:917-509-2870
Practice Address - Fax:212-568-5872
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0104022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic