Provider Demographics
NPI:1649340985
Name:NUSSBAUM, LARRY JAY (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JAY
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:401 W 2ND ST
Mailing Address - Street 2:SUITE 235D
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5345
Mailing Address - Country:US
Mailing Address - Phone:775-382-8175
Mailing Address - Fax:775-327-2006
Practice Address - Street 1:5190 NEIL RD
Practice Address - Street 2:215
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6599
Practice Address - Country:US
Practice Address - Phone:775-784-4917
Practice Address - Fax:775-784-1428
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-11-22
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Provider Licenses
StateLicense IDTaxonomies
NV51312084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507985Medicaid
NVCR694YMedicare PIN