Individual
DR. JACQUELINE I NUSSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
77 QUAKER RIDGE RD, SUITE 206, NEW ROCHELLE, NY 10804-2808
(917) 636-4118
Mailing address
65 MAGNOLIA LN, JERICHO, NY 11753-2228
(516) 938-1747
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
046469
NY
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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