Provider Demographics
NPI:1821096017
Name:NUSSBAUM, DAVID N (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:NUSSBAUM
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 1:6-15 15TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1603
Mailing Address - Country:US
Mailing Address - Phone:201-791-7991
Mailing Address - Fax:
Practice Address - Street 1:35 FIVE MILE WOODS RD
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-5913
Practice Address - Country:US
Practice Address - Phone:518-943-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003109-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCL 1109OtherPALMETTO GBA-RAILROAD MED
NY00580612Medicaid
NYT32091Medicare UPIN
NY00580612Medicaid
NY0359830002Medicare NSC