Provider Demographics
NPI:1477705002
Name:NUSSBAUM, ELLIOT Y (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:Y
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 MEADOWVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2045
Mailing Address - Country:US
Mailing Address - Phone:201-406-0624
Mailing Address - Fax:
Practice Address - Street 1:180 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-3516
Practice Address - Country:US
Practice Address - Phone:800-447-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03232600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist