Provider Demographics
NPI:1528384633
Name:NUSBLATT, ADAM MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MICHAEL
Last Name:NUSBLATT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4804
Mailing Address - Country:US
Mailing Address - Phone:631-988-8593
Mailing Address - Fax:
Practice Address - Street 1:60 E 9TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6402
Practice Address - Country:US
Practice Address - Phone:212-473-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist