Provider Demographics
NPI:1225210602
Name:NUSSBAUM, ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 STUYVESANT PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-2417
Mailing Address - Country:US
Mailing Address - Phone:516-295-5339
Mailing Address - Fax:
Practice Address - Street 1:6 STUYVESANT PL
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-2417
Practice Address - Country:US
Practice Address - Phone:516-295-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0418491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics