Individual
MICHELLE NISENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1320 WEST MAIN ST, BLDG 2, WATERBURY, CT 06708
(203) 755-9355
(203) 597-8192
Mailing address
1320 WEST MAIN ST, BLDG 2, WATERBURY, CT 06708
(203) 755-9355
(203) 597-8192
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
043409
CT
208VP0014X
Interventional Pain Medicine Physician
Primary
043409
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001434092
—
CT
01
—
010043409CT01
ANTHEM BCBS OF CT
CT
01
—
043409
CONNECTICARE
—
01
—
2525598
UNITED HEALTH CARE
—
01
—
2771432
CIGNA
—
01
—
2V7481
HEALTH NET
—
01
—
3821999
AETNA US HEALTH CARE
—
01
—
P00296425
RAILROAD MEDICARE
—
01
—
P3673144
OXFORD
—
Enumeration date
10/17/2006
Last updated
09/12/2012
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