Individual
JOSEF NISENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
126 DIAMOND TAIL RD, PLACITAS, NM 87043-8338
(505) 264-3550
(505) 332-6921
Mailing address
126 DIAMOND TAIL RD, PLACITAS, NM 87043-8338
(505) 264-3550
(505) 332-6921
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A-1195-02
NM
2085R0204X
Vascular & Interventional Radiology Physician
A-1195-02
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31201059
—
NM
Enumeration date
06/09/2005
Last updated
11/21/2019
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