Provider Demographics
NPI:1831269950
Name:KATSNELSON, NELLY (MD)
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:KATSNELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 89TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-7834
Mailing Address - Country:US
Mailing Address - Phone:718-920-4295
Mailing Address - Fax:718-920-6538
Practice Address - Street 1:MMC - DEPT. OF PSYCHIATRY
Practice Address - Street 2:111 EAST 210TH STREET, KLAU 1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1775242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry