Individual
ANDREA NISSENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2601 OCEAN PKWY, BROOKLYN, NY 11235-7745
(718) 616-4408
(718) 616-4105
Mailing address
2636 E 64TH ST, BROOKLYN, NY 11234-6816
(718) 763-8972
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
149201-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00772087
—
NY
Enumeration date
08/11/2006
Last updated
07/08/2007
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