Jack Andrew Nelson, OMFS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0429341 Issued in NY

Practice address

240 W Montauk Hwy
Hampton Bays, NY 11946-3510

Phone

(631) 728-1300

Fax

(631) 728-5165

NPI assigned

Oct 10, 2006

Last updated

Mar 10, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jun 2, 2016 through Jun 2, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• East End Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Hampton Bays, NY
  • NPI 1013225887
  Authorized official Same address or phone

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457568000000",
    "number": "1629166590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W MONTAUK HWY",
            "city": "HAMPTON BAYS",
            "state": "NY",
            "postal_code": "119463510",
            "telephone_number": "631-728-1300",
            "fax_number": "631-728-5165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W MONTAUK HWY",
            "city": "HAMPTON BAYS",
            "state": "NY",
            "postal_code": "119463510",
            "telephone_number": "631-728-1300",
            "fax_number": "631-728-5165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JACK",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "OMFS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2016-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "0429341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01548470",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sonia A. Morlani, LCSW
• Catherine M Morris
• Meciko A Muharemovic, M.D.
• Shannon Marie Munday
• Denis Nankervis Jr., D.O.
• Catherine Nemazi-Hilton, MA,PT
• New York Dermatology & Mohs Surgery Group, PLLC
• Trang Bichngoc Nguyen, D.O.
• Maryann Patricia Noble, RN
• Beverly Nogaro, R.N.

• Oral and Maxillofacial Surgery (Dentist) in Hampton Bays, NY
• Providers in Hampton Bays, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.