Provider Demographics
NPI:1760506596
Name:NUSSBAUM, ALAN C (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:C
Last Name:NUSSBAUM
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 1:603 SIERRA VISTA LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2715
Mailing Address - Country:US
Mailing Address - Phone:845-486-2703
Mailing Address - Fax:845-790-2199
Practice Address - Street 1:603 SIERRA VISTA LN
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2715
Practice Address - Country:US
Practice Address - Phone:845-486-2703
Practice Address - Fax:845-790-2199
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1815702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY181570Medicaid
NYF34555Medicare UPIN