Provider Demographics
NPI:1407182827
Name:NUSSBAUM, TOVA ITA (MS CF-SLP, TSSLD)
Entity Type:Individual
Prefix:MISS
First Name:TOVA
Middle Name:ITA
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:MS CF-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W 250TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2925
Mailing Address - Country:US
Mailing Address - Phone:718-549-4753
Mailing Address - Fax:
Practice Address - Street 1:475 W 250TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2925
Practice Address - Country:US
Practice Address - Phone:718-549-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist