Provider Demographics
NPI:1760455380
Name:NUSBAUM, H J (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:J
Last Name:NUSBAUM
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12-14 WESTON ST.
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120
Mailing Address - Country:US
Mailing Address - Phone:860-293-3101
Mailing Address - Fax:860-293-3117
Practice Address - Street 1:345 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1824
Practice Address - Country:US
Practice Address - Phone:860-293-3101
Practice Address - Fax:869-293-3117
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034445207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001344457Medicaid
CT23144OtherCONTROLLED SUBSTANCE
CT034445OtherSTATE LICENSE
CTG10276Medicare UPIN
CT160002405Medicare PIN