Provider Demographics
NPI:1639237928
Name:NUSSBAUM, ERIC DEAN (ATC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DEAN
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 DERBY DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2767
Mailing Address - Country:US
Mailing Address - Phone:732-303-0737
Mailing Address - Fax:
Practice Address - Street 1:112 DERBY DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2767
Practice Address - Country:US
Practice Address - Phone:732-303-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist