Provider Demographics
NPI:1780041004
Name:NUSSBAUM, MALKA J (MA)
Entity Type:Individual
Prefix:MRS
First Name:MALKA
Middle Name:J
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:MALKA
Other - Middle Name:J
Other - Last Name:LOWENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3266
Mailing Address - Country:US
Mailing Address - Phone:732-802-7377
Mailing Address - Fax:732-802-7378
Practice Address - Street 1:301 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3266
Practice Address - Country:US
Practice Address - Phone:732-802-7377
Practice Address - Fax:732-802-7378
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-2643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist