Provider Demographics
NPI:1881618304
Name:NELSON, JONATHAN LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LAWRENCE
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CEDAR ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2031
Mailing Address - Country:US
Mailing Address - Phone:914-251-9110
Mailing Address - Fax:914-921-4877
Practice Address - Street 1:33 CEDAR ST
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2031
Practice Address - Country:US
Practice Address - Phone:914-251-9110
Practice Address - Fax:914-921-4877
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222467-2174400000X
NY222467207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2K787EF231Medicare PIN
NYH73466Medicare UPIN