Basic Information
| Provider Information | |||||||||
| NPI: | 1316941776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENG | ||||||||
| FirstName: | NELSON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8517 66TH AVE | ||||||||
| Address2: | |||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113745209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188960229 | ||||||||
| FaxNumber: | 7189603635 | ||||||||
| Practice Location | |||||||||
| Address1: | 470 E FORDHAM RD | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189603805 | ||||||||
| FaxNumber: | 7189603806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 04/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 183545 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1348576 | 05 | NY | MEDICAID |