Provider Demographics
NPI:1659583805
Name:NITSBERG, BRUCE JAY (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:JAY
Last Name:NITSBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 EAST BROADWAY
Mailing Address - Street 2:#6U
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561
Mailing Address - Country:US
Mailing Address - Phone:516-889-8448
Mailing Address - Fax:
Practice Address - Street 1:860 EAST BROADWAY
Practice Address - Street 2:#6U
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561
Practice Address - Country:US
Practice Address - Phone:516-889-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA095187207RR0500X
FLMF 16300207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY522671Medicare ID - Type Unspecified
FL78387Medicare ID - Type Unspecified