Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 150073 | NY |
N | 207X00000X | Orthopaedic Surgeon | 28357 | CT |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 150073 | NY |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 28357 | CT |
NPI | 1245328103 |
---|---|
Provider Name | John Martin Nelson JR. |
First Address | Purchase, NY 10577-2535 |
Second Address | Purchase, NY 10577-2535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 03/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00970338 | (05) | NY |
A62671 | (02) |