Healthcare Provider Details

I. General information

NPI: 1821194820
Provider Name (Legal Business Name): ELIEZER NUSSBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

PO BOX 1307
LONG BEACH CA
90801-1307
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-8740
  • Fax:
Mailing address:
  • Phone: 562-933-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA33713
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA33713
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberA33713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: