Provider Demographics
NPI:1578598082
Name:NUSSBAUM, ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:91 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1146
Mailing Address - Country:US
Mailing Address - Phone:845-876-4095
Mailing Address - Fax:845-876-4427
Practice Address - Street 1:91 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1146
Practice Address - Country:US
Practice Address - Phone:845-876-4095
Practice Address - Fax:845-876-4427
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131586208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10489688OtherCAQH
NYP396195OtherOXFORD HEALTH PLAN
NY10032008OtherCDPHP
NY00429290Medicaid
NY267172OtherMVP HEALTH PLAN
NY00429290Medicaid