Provider Demographics
NPI:1356478408
Name:NOCHIMSON, DAVID JACOB (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JACOB
Last Name:NOCHIMSON
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 1:15 DONAHUE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06060-1404
Mailing Address - Country:US
Mailing Address - Phone:860-653-3466
Mailing Address - Fax:860-653-3238
Practice Address - Street 1:15 DONAHUE RD
Practice Address - Street 2:
Practice Address - City:NORTH GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06060-1404
Practice Address - Country:US
Practice Address - Phone:860-653-3466
Practice Address - Fax:860-653-3238
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021601207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1216019Medicaid
NJ1216019Medicaid