Provider Demographics
NPI:1598995532
Name:NUSSBAUM, DREW JONATHAN (DREW NUSSBAUM DC)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:JONATHAN
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:DREW NUSSBAUM DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 ALBANY CT
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-8339
Mailing Address - Country:US
Mailing Address - Phone:201-721-6130
Mailing Address - Fax:201-918-6864
Practice Address - Street 1:436 ALBANY CT
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-8339
Practice Address - Country:US
Practice Address - Phone:201-721-6130
Practice Address - Fax:201-918-6864
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00675900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor