Nussbaum, Jack Z

Nussbaum, Jack Z is an individual health care provider with primary practice located at 388 Hawkins Ave Ste 1, Lake Ronkonkoma NY 11779-4280. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Nussbaum, Jack Z can be contacted via phone (631) 588-8460.

Contact Information

Primary practice address
388 Hawkins Ave Ste 1 Lake Ronkonkoma NY 11779-4280
Phone: (631) 588-8460
Fax: (631) 588-8480
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 165161 New York

Profile Details

NPI number 1346242690
LBN Legal business name Nussbaum, Jack Z
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346242690 NPPES
New York MEDICAID 01824322

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