Provider Demographics
NPI:1588682686
Name:NUSSBAUM, JAMES A (PHD, MSPT, CSCS, EMT)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:PHD, MSPT, CSCS, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W END AVE
Mailing Address - Street 2:SUITE # 1M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4902
Mailing Address - Country:US
Mailing Address - Phone:212-600-4781
Mailing Address - Fax:800-655-3780
Practice Address - Street 1:180 W END AVE
Practice Address - Street 2:SUITE # 1M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4902
Practice Address - Country:US
Practice Address - Phone:212-600-4781
Practice Address - Fax:800-655-3780
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020992225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ09U41Medicare PIN