Provider Demographics
NPI:1659334803
Name:NUNBERG, NELSON ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:ROBERT
Last Name:NUNBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2506
Mailing Address - Country:US
Mailing Address - Phone:617-492-0305
Mailing Address - Fax:
Practice Address - Street 1:17A BENNINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1719
Practice Address - Country:US
Practice Address - Phone:617-567-3338
Practice Address - Fax:617-567-0822
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1760213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT58766Medicare UPIN
MAY70793Medicare ID - Type Unspecified