Provider Demographics
NPI:1467595397
Name:ADAM T. NOMBERG, M.D, P.C.
Entity Type:Organization
Organization Name:ADAM T. NOMBERG, M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-935-4141
Mailing Address - Street 1:100 MANETTO HILL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1311
Mailing Address - Country:US
Mailing Address - Phone:516-935-4141
Mailing Address - Fax:516-935-1770
Practice Address - Street 1:100 MANETTO HILL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1311
Practice Address - Country:US
Practice Address - Phone:516-935-4141
Practice Address - Fax:516-935-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197495207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01753828Medicaid
NY01753828Medicaid
NYG63262Medicare UPIN