Individual
DR. MICHAEL NUSSBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
270 UNION AVE, HOLBROOK, NY 11741-1823
(631) 588-4442
Mailing address
62 OLD HOMESTEAD RD, PORT JEFFERSON, NY 11777-1185
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
124424
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00306170
—
NY
Enumeration date
08/24/2006
Last updated
11/22/2011
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