Provider Demographics
NPI:1184659310
Name:NISSMAN, STEVEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:NISSMAN
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 1:699 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1073
Mailing Address - Country:US
Mailing Address - Phone:610-834-1800
Mailing Address - Fax:610-834-1811
Practice Address - Street 1:699 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1073
Practice Address - Country:US
Practice Address - Phone:610-834-1800
Practice Address - Fax:610-834-1811
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425959207W00000X
NJMA07892400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01705OtherHEALTH PARTNERS - FRANK
PA1381889OtherCIGNA
PA101695040OtherAMERICHOICE
PA30035423OtherKEYSTONE MERCY
PA1381889OtherPREFERRED CARE
PA27807OtherHEALTH PARTNERS - NORTH
I55871OtherUPIN
PA101695040Medicaid
PA2757673000OtherBCBS
PAP3741343OtherOXFORD
NJ0069477Medicaid
PA15876OtherELDER HEALTH
NJ2675838000OtherAMERIHEALTH
PA100187OtherFIRST HEALTH
PA101659040OtherUNITED HEALTHCARE
PA1406670OtherAETNA
PA1892627OtherHIGHMARK BS
NJ1915176OtherHIGHMARK BS
PA7053856OtherAETNA
NJ104142Medicare PIN
PA1381889OtherCIGNA