Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC002195L | PA |
Y | 222Z00000X | Podiatrist | SC002195L | PA |
N | 2081S0010X | Sports Medicine | SC-002195-L | PA |
N | 213ES0000X | Sports Medicine | SC-002195-L | PA |
NPI | 1457434433 |
---|---|
Provider Name | Howard Nelson |
First Address | Feasterville Trevose, PA 19053-6064 |
Second Address | Feasterville Trevose, PA 19053-6064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 23/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0589238 | (05) | PA |