Provider Demographics
NPI:1548342868
Name:ASSAEL, NELSON R (DMD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:R
Last Name:ASSAEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-487-4100
Mailing Address - Fax:516-487-4041
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-487-4100
Practice Address - Fax:516-487-4041
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0341901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50298Medicare UPIN
NYD9D331Medicare ID - Type Unspecified