Provider Demographics
NPI:1467981704
Name:NUSSBAUM, ELIEZER ZACHARY (MD)
Entity Type:Individual
Prefix:
First Name:ELIEZER ZACHARY
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ZACH
Other - Middle Name:
Other - Last Name:NUSSBAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:BUL-130
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-3812
Mailing Address - Fax:617-726-3755
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:BUL-130
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-3812
Practice Address - Fax:617-726-3755
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA283372207RI0200X
390200000X
MA1013347207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program