Provider Demographics
NPI:1912931866
Name:NUSBAUM, MOREYE (MD)
Entity Type:Individual
Prefix:
First Name:MOREYE
Middle Name:
Last Name:NUSBAUM
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 1:39TH MARKET ST
Mailing Address - Street 2:BLDG WS 266
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2699
Mailing Address - Country:US
Mailing Address - Phone:215-662-8026
Mailing Address - Fax:215-382-2272
Practice Address - Street 1:39TH MARKET ST
Practice Address - Street 2:BLDG WS 266
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2699
Practice Address - Country:US
Practice Address - Phone:215-662-8026
Practice Address - Fax:215-382-2272
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025248L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
014735Medicare ID - Type Unspecified
B32339Medicare UPIN