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Individual
ROBERT NIELSON
Active
Individual
ROBERT NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
147659
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000401351002
BLUE SHIELD
NY
05
—
01245909
—
NY
01
—
040426007158
FIDELIS
NY
01
—
08563
MVP
NY
01
—
10023164
CDPHP
NY
01
—
2P77010
EMPIRE BLUE CROSS
NY
01
—
47104
GHI HMO
NY
01
—
77856137
AETNA
NY
Enumeration date
03/02/2006
Last updated
10/12/2015
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