Individual
DR. MATTHEW A NISSENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
221 N WELLWOOD AVE, LINDENHURST, NY 11757-3706
(631) 225-8000
(631) 225-7077
Mailing address
221 N WELLWOOD AVE, LINDENHURST, NY 11757-3706
(631) 225-8000
(631) 225-7077
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
048062-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02771180
—
NY
Enumeration date
03/16/2007
Last updated
07/08/2007
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