Provider Demographics
NPI:1841425196
Name:NUSSBAUM, CHARLOTTE SIMONE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:SIMONE
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 STOKES RD STE 4-168
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3097
Mailing Address - Country:US
Mailing Address - Phone:609-969-4844
Mailing Address - Fax:609-969-4255
Practice Address - Street 1:30 JACKSON RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9283
Practice Address - Country:US
Practice Address - Phone:609-969-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09337600202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine