Provider Demographics
NPI:1114963345
Name:NUSSBAUM, STEVEN JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOEL
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 MINDEN WAY
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2323
Mailing Address - Country:US
Mailing Address - Phone:610-246-7152
Mailing Address - Fax:
Practice Address - Street 1:300B LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4289
Practice Address - Country:US
Practice Address - Phone:610-836-5990
Practice Address - Fax:610-836-5998
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMDV002383207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078330602Medicaid
PA078330602Medicaid
C29659Medicare UPIN