Organization
MICHAEL L NISSNBAUM, PH.D., PSYCHOLOGIST, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL LEONARD NISSENBAUM PH.D. (PRESIDENT)
(631) 737-9500
Entity
Organization
Contact information
Practice address
4 COED LN, STONY BROOK, NY 11790-2704
(631) 737-9500
(631) 737-9512
Mailing address
4 COED LN, STONY BROOK, NY 11790-2704
(631) 737-9500
(631) 737-9512
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
010232
NY
Other
Enumeration date
04/08/2008
Last updated
07/01/2008
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