Individual provider Active NPI

John D Nelson, DDS

  • Periodontics
  • New York, NY
National Provider Identifier
1083003990
Registry record updated Jan 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
031343 Issued in NY
Practice address
133 E 58TH St
Suite 403
New York, NY 10022-1236
Phone
(646) 812-0261
NPI assigned
Jan 15, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 031343 NY Primary

Addresses

Primary practice location

133 E 58TH St
Suite 403
New York, NY 10022-1236

Mailing address

133 E 58TH St
Suite 403
New York, NY 10022-1236
Phone (646) 812-0261

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151105002050 NY Order and Referring Only - DentistPractitioner - Dentist 3476863325

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421280000000",
    "number": "1083003990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 E 58TH ST",
            "address_2": "SUITE 403",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100221236",
            "telephone_number": "646-812-0261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 E 58TH ST",
            "address_2": "SUITE 403",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100221236",
            "telephone_number": "646-812-0261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JOHN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-15",
        "last_updated": "2015-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "031343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.