Provider Demographics
NPI:1225296098
Name:NUSBAUM, ILANA ESTER
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:ESTER
Last Name:NUSBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ILANA
Other - Middle Name:ESTER
Other - Last Name:FINKELSZTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1824 SPRUCE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:617-784-7222
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:718-270-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1950422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry