Organization
SURGICAL GROUP PROF CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY K NUSSBAUM M.D. (PRESIDENT)
(631) 598-7757
Entity
Organization
Contact information
Practice address
157 BROADWAY, AMITYVILLE, NY 11701-2729
(631) 598-7757
(631) 598-7759
Mailing address
157 BROADWAY, AMITYVILLE, NY 11701-2729
(631) 598-7757
(631) 598-7759
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
147879
NY
2086S0129X
Vascular Surgery Physician
147879
NY
Other
Enumeration date
02/06/2009
Last updated
02/06/2009
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