Active NPI
Robert Bruce Nelson, P.A.
- Physician Assistant
- Westbury, NY
National Provider Identifier
1477637890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 000777
- Practice address
- 1500 Jericho Tpke
Westbury, NY 11590-1045 - Phone
- (516) 877-2400
- Fax
- (516) 877-1897
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 000777 | NY | Primary |
Addresses
Primary practice location
1500 Jericho Tpke
Westbury, NY 11590-1045
Mailing address
825 E Gate Blvd Ste 111
Garden City, NY 11530-2136
Phone (516) 804-5200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01564227 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000777 | NY | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Vision Cataract Center LLC | Current | Accepting new patients |
Locations
825 E Gate Blvd
Ste 111
Garden City, NY 11530
Phone (516) 804-5200
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568678400000",
"number": "1477637890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 E GATE BLVD STE 111",
"city": "GARDEN CITY",
"state": "NY",
"postal_code": "115302136",
"telephone_number": "516-804-5200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 JERICHO TPKE",
"city": "WESTBURY",
"state": "NY",
"postal_code": "115901045",
"telephone_number": "516-877-2400",
"fax_number": "516-877-1897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "ROBERT",
"middle_name": "BRUCE",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2019-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "000777",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01564227",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Westbury, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.