Healthcare Provider Details

I. General information

NPI: 1487074241
Provider Name (Legal Business Name): KAREN NUSSBAUMER DDG, BS, RDMS, RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RESERVE RD # 4F
DANBURY CT
06810-5267
US

IV. Provider business mailing address

41 TRUESDALE LAKE DR
SOUTH SALEM NY
10590-1317
US

V. Phone/Fax

Practice location:
  • Phone: 855-663-2366
  • Fax: 914-663-5555
Mailing address:
  • Phone: 914-233-7785
  • Fax: 914-663-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number92676
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number22035
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number0001
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number92676
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number92676
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number92676
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number92676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: