Provider Demographics
NPI:1982970604
Name:NUSSBAUM, ALEXANDRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 STUYVESANT OVAL
Mailing Address - Street 2:APT 9C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2420
Mailing Address - Country:US
Mailing Address - Phone:201-410-8955
Mailing Address - Fax:
Practice Address - Street 1:1165 MORRIS PARK AVE
Practice Address - Street 2:ROUSSO ANNEX
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1915
Practice Address - Country:US
Practice Address - Phone:718-430-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021789-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist