Individual
JACK E NISSIM
Active
Individual
JACK E NISSIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M./D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
D0012942
MD
207RP1001X
Pulmonary Disease Physician
Primary
D0012942
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005 E554
BLUE CHOICE/FEP
MD
01
—
274550
UNITED HEALTHCARE
—
01
—
290010917
RAILROAD MEDICARE
—
01
—
34438002 420A
BLUE SHIELD
MD
01
—
4800034
UNITED HEALTHCARE MCO
—
05
—
789201200
—
MD
Enumeration date
10/19/2006
Last updated
08/28/2012
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