Nelson, Jack Andrew
Nelson, Jack Andrew is an individual health care provider with primary practice located at 240 W Montauk Hwy , Hampton Bays NY 11946-3510. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Nelson, Jack Andrew can be contacted via phone (631) 728-1300.Contact Information
Primary practice address
240 W Montauk Hwy
Hampton Bays NY 11946-3510
Phone: (631) 728-1300
Fax: (631) 728-5165
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 0429341 | New York |
Profile Details
| NPI number | 1629166590 |
|---|---|
| LBN Legal business name | Nelson, Jack Andrew |
| Credentials | OMFS |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 10th, 2006 |
| Last updated | Mar 10th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629166590 | NPPES |
| New York | MEDICAID | 01548470 |
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