Individual
DR. JACK ANDREW NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OMFS
Contact information
Practice address
240 W MONTAUK HWY, HAMPTON BAYS, NY 11946-3510
(631) 728-1300
(631) 728-5165
Mailing address
240 W MONTAUK HWY, HAMPTON BAYS, NY 11946-3510
(631) 728-1300
(631) 728-5165
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0429341
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01548470
—
NY
Enumeration date
10/10/2006
Last updated
03/10/2016
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