Provider Demographics
NPI:1649896416
Name:ADAM M NUSBLATT, DMD PC
Entity type:Organization
Organization Name:ADAM M NUSBLATT, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-988-8593
Mailing Address - Street 1:60 E 9TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6403
Mailing Address - Country:US
Mailing Address - Phone:212-473-2164
Mailing Address - Fax:212-473-2165
Practice Address - Street 1:60 E 9TH ST APT 206
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6403
Practice Address - Country:US
Practice Address - Phone:212-473-2164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty